TY - JOUR
AU - N. R. Villela
AU - P. C. L. de Assunção
AU - A. C. Q. da Silva
AU - F. A. D. Flutt
AU - B. F. A. de Oliveira
A1 - 
AB - OBJECTIVES: This study aimed to evaluate the prevalence of depression and its relationship with clinical characteristics, demographics, and pain intensity in patients experiencing uncontrolled chronic pain. It also examined whether severe pain interference with daily activities mediates the connection between severe pain and depression. DESIGN: This cross-sectional observational study used data from 2,081 adult patients referred from primary care to a tertiary hospital. DATA SOURCE: Depression was assessed using the Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), with scores of 11 or higher indicating depression. Sociodemographic and clinical characteristics were collected, and pain severity and interference were evaluated with the Brief Pain Inventory (BPI). ANALYSIS: Poisson regression assessed the associations between depression and demographic/clinical factors. Mediation analysis examined the effect of severe interference on the relationship between severe pain and depression. RESULTS: Depression was found in 42.7% of patients. Those with depression reported a higher prevalence of severe pain (61% vs. 43%) and more significant interference with daily activities (81% vs. 42%). Males (PR = 0.73, 95% CI: 0.64-0.83) and patients aged 60 years or older (PR = 0.73, 95% CI: 0.64-0.83) exhibited a lower prevalence of depression. Widespread pain (PR = 1.29, 95% CI: 1.15-1.44) and severe pain (PR = 1.39, 95% CI: 1.24-1.53) were associated with a higher prevalence of depression. When severe interference was included in the regression model, the association with severe pain diminished, and severe interference emerged as a stronger predictor of depression (PR = 2.60, 95% CI: 2.24-3.02). In the mediation analysis, severe interference mediated the relationship between severe pain and depression. CONCLUSION: Depression is common among patients with uncontrolled chronic pain and is linked to significant pain and functional impairment. Addressing these functional limitations is essential for managing this population.
AD - Center of Pain, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil; Discipline of Neurosurgery, Faculty of Medical Sciences, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil; Graduate Program in Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil. Electronic address: nivaldo.villela@uerj.br.; Center of Pain, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil; Graduate Program in Clinical and Experimental Pathophysiology, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.; Center of Pain, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.; Center of Pain, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil; Oswaldo Cruz Foundation Piauí (FIOCRUZ-PI), Teresina, PI, Brazil.
AN - 40628570
BT - Pain Manag Nurs
C5 - Healthcare Disparities
CP - 1
DA - Feb
DO - 10.1016/j.pmn.2025.06.002
DP - NLM
ET - 20250707
IS - 1
JF - Pain Manag Nurs
LA - eng
N2 - OBJECTIVES: This study aimed to evaluate the prevalence of depression and its relationship with clinical characteristics, demographics, and pain intensity in patients experiencing uncontrolled chronic pain. It also examined whether severe pain interference with daily activities mediates the connection between severe pain and depression. DESIGN: This cross-sectional observational study used data from 2,081 adult patients referred from primary care to a tertiary hospital. DATA SOURCE: Depression was assessed using the Depression subscale of the Hospital Anxiety and Depression Scale (HADS-D), with scores of 11 or higher indicating depression. Sociodemographic and clinical characteristics were collected, and pain severity and interference were evaluated with the Brief Pain Inventory (BPI). ANALYSIS: Poisson regression assessed the associations between depression and demographic/clinical factors. Mediation analysis examined the effect of severe interference on the relationship between severe pain and depression. RESULTS: Depression was found in 42.7% of patients. Those with depression reported a higher prevalence of severe pain (61% vs. 43%) and more significant interference with daily activities (81% vs. 42%). Males (PR = 0.73, 95% CI: 0.64-0.83) and patients aged 60 years or older (PR = 0.73, 95% CI: 0.64-0.83) exhibited a lower prevalence of depression. Widespread pain (PR = 1.29, 95% CI: 1.15-1.44) and severe pain (PR = 1.39, 95% CI: 1.24-1.53) were associated with a higher prevalence of depression. When severe interference was included in the regression model, the association with severe pain diminished, and severe interference emerged as a stronger predictor of depression (PR = 2.60, 95% CI: 2.24-3.02). In the mediation analysis, severe interference mediated the relationship between severe pain and depression. CONCLUSION: Depression is common among patients with uncontrolled chronic pain and is linked to significant pain and functional impairment. Addressing these functional limitations is essential for managing this population.
PY - 2026
SN - 1524-9042
SP - e26
EP - e33+
ST - Pain Interference Mediates the Relationship Between Severe Pain and Depression in Patients with Chronic Pain Referred from Primary Care
T1 - Pain Interference Mediates the Relationship Between Severe Pain and Depression in Patients with Chronic Pain Referred from Primary Care
T2 - Pain Manag Nurs
TI - Pain Interference Mediates the Relationship Between Severe Pain and Depression in Patients with Chronic Pain Referred from Primary Care
U1 - Healthcare Disparities
U3 - 10.1016/j.pmn.2025.06.002
VL - 27
VO - 1524-9042
Y1 - 2026
ER -