Comparison between the Beck Depression Inventory and psychiatric evaluation of distress in patients on long-term sick leave due to chronic musculoskeletal pain

Background: Chronic musculoskeletal pain (CMP) is associated with psychological distress and long-term disability. Underlying diagnoses causing long-term sickness absence due to CMP have not been explored enough. In a somatic health care setting, it is important to identify mental health comorbidity to facilitate the selection of appropriate treatment. The objectives of this study were to compare the scores of depressed mood obtained on the Beck Depression Inventory (BDI) with the diagnosis of depression made by a psychiatrist, and to study the prevalence of undiagnosed mental health comorbidity in these patients. Methods and patients: 83 consecutive patients on sick leave (mean duration 21 months) due to CMP who had been referred by the Social Insurance Office to an orthopedist and a psychiatrist for assessment of the patient’s diagnoses and capacity to work. The mean age was 45 (23–61) years, 58% were women and 52% were immigrants. The accuracy of measurements was calculated using the Diagnostic Statistical Manual of Mental Disorders IV as the Gold standard. Results: Psychiatric illness was diagnosed in 87% of the patients. The diagnosis was depression in 56%, other psychiatric illnesses in 31%, whereas 13% were mentally healthy. Of all the patients, only 10% had a previous psychiatric diagnosis. The median value of the BDI score was 26 points in depressed patients, whereas it was 23 in patients with other psychiatric diagnoses. The sensitivity of the BDI to detect depression was 87.5%. We found good agreement between the BDI score and a diagnosis of depression. Conclusion: Undiagnosed psychiatric disorders were commonly seen in patients with CMP. The high sensitivity of the BDI scores enables the screening of mental health comorbidity in patients with a somatic dysfunction. The test is a useful tool for detecting distress in patients who are on long-term sick leave due to CMP and who need additional treatment.

[1]  G. Crombez,et al.  The Fear-Avoidance Model of Musculoskeletal Pain: Current State of Scientific Evidence , 2006, Journal of Behavioral Medicine.

[2]  U. Lundberg,et al.  Stress Responses in Low‐Status Jobs and Their Relationship to Health Risks: Musculoskeletal Disorders , 1999, Annals of the New York Academy of Sciences.

[3]  R A Steer,et al.  Use of the Beck Depression Inventory for Primary Care to screen for major depression disorders. , 1999, General hospital psychiatry.

[4]  T. Pincus,et al.  Depressed cognitions in chronic pain patients are focused on health: Evidence from a sentence completion task , 2007, PAIN.

[5]  J. Styf,et al.  Illness behavior in patients on long-term sick leave due to chronic musculoskeletal pain , 2009, Acta orthopaedica.

[6]  A. Beck,et al.  Screening for major depression disorders in medical inpatients with the Beck Depression Inventory for Primary Care. , 1997, Behaviour research and therapy.

[7]  S. Morley,et al.  A confirmatory factor analysis of the Beck Depression Inventory in chronic pain , 2002, PAIN.

[8]  B. Röhrig,et al.  Requestioning depression in patients with cancer: contribution of somatic and affective symptoms to Beck's Depression Inventory. , 2007, Annals of oncology : official journal of the European Society for Medical Oncology.

[9]  S. Ridner,et al.  Psychological distress: concept analysis. , 2004, Journal of advanced nursing.

[10]  Heinrich Sauer,et al.  On the Validity of the Beck Depression Inventory , 1998, Psychopathology.

[11]  Barbara M. Byrne,et al.  Validating the Beck Depression Inventory-II for Hong Kong Community Adolescents , 2004 .

[12]  A. Beck,et al.  Internal consistencies of the original and revised Beck Depression Inventory. , 1984, Journal of clinical psychology.

[13]  R. Bedi,et al.  A multisample item response theory analysis of the Beck Depression Inventory-1A , 2001 .

[14]  S. Hammond.  An IRT Investigation of the Validity of Non-Patient Analogue Research Using the Beck Depression Inventory , 1995 .

[15]  A. Silman,et al.  Risk factors for persistent chronic widespread pain: a community-based study. , 2001, Rheumatology.

[16]  H. Flor,et al.  Efficacy of multidisciplinary pain treatment centers: a meta-analytic review , 1992, Pain.

[17]  D. Andrén.  Long-term absenteeism due to sickness in Sweden. How long does it take and what happens after? , 2007, The European Journal of Health Economics.

[18]  W. David Leak,et al.  Handbook of Pain Assessment , 1994 .

[19]  S. Stahl.  Does depression hurt? , 2002, The Journal of clinical psychiatry.

[20]  M E Robinson,et al.  Assessing depression among persons with chronic pain using the Center for Epidemiological Studies-Depression Scale and the Beck Depression Inventory: a comparative analysis. , 1997, The Clinical journal of pain.

[21]  J. Greer,et al.  Predictors of Physician-Patient Agreement on Symptom Etiology in Primary Care , 2006, Psychosomatic medicine.

[22]  D. Turk,et al.  Chronic pain and depression: toward a cognitive-behavioral mediation model , 1988, Pain.

[23]  E. Kalso,et al.  Pain intensity influences the relationship between anger management style and depression , 2008, PAIN.

[24]  S. Linton,et al.  Early Identification of Patients at Risk of Developing a Persistent Back Problem: The Predictive Validity of The Örebro Musculoskeletal Pain Questionnaire , 2003, The Clinical journal of pain.

[25]  S. Andersson,et al.  Relations between self-rated musculoskeletal symptoms and signs and psychological distress in chronic neck and shoulder pain. , 1998, Scandinavian journal of rehabilitation medicine.

[26]  A. Burton,et al.  Psychosocial Predictors of Outcome in Acute and Subchronic Low Back Trouble , 1995, Spine.

[27]  S. Linton,et al.  Can Chronic Disability Be Prevented?: A Randomized Trial of a Cognitive-Behavior Intervention and Two Forms of Information for Patients With Spinal Pain , 2000, Spine.

[28]  J. D'eon,et al.  Psychometric properties of the Beck Depression Inventory-Second Edition (BDI-II) in individuals with chronic pain , 2008, PAIN®.

[29]  B. Collett,et al.  Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment , 2006, European journal of pain.

[30]  L. Klenerman,et al.  The Prediction of Chronicity in Patients With an Acute Attack of Low Back Pain in a General Practice Setting , 1995, Spine.

[31]  Amanda C.C. Williams,et al.  What does the BDI measure in chronic pain? , 1993, Pain.

[32]  R. Downey,et al.  Missing data in Likert ratings: A comparison of replacement methods. , 1998, The Journal of general psychology.

[33]  I. Jensen,et al.  Risk factors for new episodes of sick leave due to neck or back pain in a working population. A prospective study with an 18-month and a three-year follow-up , 2006, Occupational and Environmental Medicine.

[34]  S. Currie,et al.  Chronic back pain and major depression in the general Canadian population , 2004, Pain.

[35]  J. Turner,et al.  Self-report screening measures for depression in chronic pain patients. , 1984, Journal of clinical psychology.

[36]  J. Vlaeyen,et al.  Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity , 2005, European journal of pain.

[37]  S. Marklund,et al.  Den höga sjukfrånvaron - : sanning och konsekvens , 2004 .

[38]  A. Beck,et al.  Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. , 1996, Journal of personality assessment.

[39]  Richel Lousberg,et al.  Validity of the beck depression inventory, hospital anxiety and depression scale, SCL-90, and hamilton depression rating scale as screening instruments for depression in stroke patients. , 2002, Psychosomatics.