The effect of pain on presence and severity of depressive disorders in older persons: The role of perceived control as mediator.
BACKGROUND
The relation between pain and depression is reported repeatedly. It is suggested that pain by itself is not sufficient for the development of depression. We aim to study the role of perceived control as mediating factor in the relation between pain and depressive disorders at old age.


METHODS
Baseline data of the Netherlands Study of Depression in Older Persons (NESDO) were used, including 345 persons with DSM-IV depressive disorders (CIDI) and 125 control persons without depressive disorders, aged 60 years and over. Measures included severity of depression (Inventory of Depressive Symptomatology), presence and intensity of pain and pain-related disability (Chronic Graded Pain scale), and a general measure of perceived control over life (Pearlin Mastery Scale). In mediation analyses direct and indirect effects were estimated.


RESULTS
Older persons with depressive disorders reported pain more frequently with higher intensity than controls. After controlling for confounding, the direct effect of pain intensity and the indirect effect through perceived control on depression were OR=1.10 (CI 95% .98;1.25) and OR=1.24 (1.15;1.35). For pain-related disability these were OR=1.14 (1.02;1.29) and OR=1.21 (1.13;1.29). In depressed persons there was a strong direct effect of pain intensity and disability and a smaller indirect effect through perceived control on severity of depressive symptoms.


LIMITATIONS
This cross-sectional study cannot give evidence on causal direction.


CONCLUSIONS
Perceived control plays an important role as mediator in the association between pain and presence of depression. In depressed persons however, the direct role of pain seems more important in the association with depression severity.
['de Waal|M W M|MW|', 'Hegeman|J M|JM|', 'Gussekloo|J|J|', 'Verhaak|P F M|PF|', 'van der Mast|R C|RC|', 'Comijs|H C|HC|']
D000368:Aged D059350:Chronic Pain D003430:Cross-Sectional Studies D003863:Depression D003865:Depressive Disorder, Major D039721:Diagnostic and Statistical Manual of Mental Disorders D006233:Disabled Persons D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D009426:Netherlands D010147:Pain Measurement D058748:Pain Perception D012720:Severity of Illness Index
Pain Depressive disorder Perceived control Mediator Aged