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Cohen A, Naslund J, Lane E, Bhan A, Rozatkar A, Mehta UM, Vaidyam A, Byun AJS, Barnett I, Torous J. Digital phenotyping data and anomaly detection methods to assess changes in mood and anxiety symptoms across a transdiagnostic clinical sample. Acta Psychiatr Scand 2024. [PMID: 38807465 DOI: 10.1111/acps.13712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 04/14/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Clinical assessment of mood and anxiety change often relies on clinical assessment or self-reported scales. Using smartphone digital phenotyping data and resulting markers of behavior (e.g., sleep) to augment clinical symptom scores offers a scalable and potentially more valid method to understand changes in patients' state. This paper explores the potential of using a combination of active and passive sensors in the context of smartphone-based digital phenotyping to assess mood and anxiety changes in two distinct cohorts of patients to assess the preliminary reliability and validity of this digital phenotyping method. METHODS Participants from two different cohorts, each n = 76, one with diagnoses of depression/anxiety and the other schizophrenia, utilized mindLAMP to collect active data (e.g., surveys on mood/anxiety), along with passive data consisting of smartphone digital phenotyping data (geolocation, accelerometer, and screen state) for at least 1 month. Using anomaly detection algorithms, we assessed if statistical anomalies in the combination of active and passive data could predict changes in mood/anxiety scores as measured via smartphone surveys. RESULTS The anomaly detection model was reliably able to predict symptom change of 4 points or greater for depression as measured by the PHQ-9 and anxiety as measured for the GAD-8 for both patient populations, with an area under the ROC curve of 0.65 and 0.80 for each respectively. For both PHQ-9 and GAD-7, these AUCs were maintained when predicting significant symptom change at least 7 days in advance. Active data alone predicted around 52% and 75% of the symptom variability for the depression/anxiety and schizophrenia populations respectively. CONCLUSION These results indicate the feasibility of anomaly detection for predicting symptom change in transdiagnostic cohorts. These results across different patient groups, different countries, and different sites (India and the US) suggest anomaly detection of smartphone digital phenotyping data may offer a reliable and valid approach to predicting symptom change. Future work should emphasize prospective application of these statistical methods.
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Affiliation(s)
- Asher Cohen
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - John Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Erlend Lane
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Abhijit Rozatkar
- Department of Psychiatry, AIIMS Bhopal, All India Institute of Medical Sciences Bhopal, Bhopal, India
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, India
- National Institute of Advanced Studies, Bangalore, India
| | - Aditya Vaidyam
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Jin Soo Byun
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ian Barnett
- Department of Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
| | - John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Chaturvedi J, Stewart R, Ashworth M, Roberts A. Distributions of recorded pain in mental health records: a natural language processing based study. BMJ Open 2024; 14:e079923. [PMID: 38642997 PMCID: PMC11033644 DOI: 10.1136/bmjopen-2023-079923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/28/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVE The objective of this study is to determine demographic and diagnostic distributions of physical pain recorded in clinical notes of a mental health electronic health records database by using natural language processing and examine the overlap in recorded physical pain between primary and secondary care. DESIGN, SETTING AND PARTICIPANTS The data were extracted from an anonymised version of the electronic health records of a large secondary mental healthcare provider serving a catchment of 1.3 million residents in south London. These included patients under active referral, aged 18+ at the index date of 1 July 2018 and having at least one clinical document (≥30 characters) between 1 July 2017 and 1 July 2019. This cohort was compared with linked primary care records from one of the four local government areas. OUTCOME The primary outcome of interest was the presence of recorded physical pain within the clinical notes of the patients, not including psychological or metaphorical pain. RESULTS A total of 27 211 patients were retrieved. Of these, 52% (14,202) had narrative text containing relevant mentions of physical pain. Older patients (OR 1.17, 95% CI 1.15 to 1.19), females (OR 1.42, 95% CI 1.35 to 1.49), Asians (OR 1.30, 95% CI 1.16 to 1.45) or black (OR 1.49, 95% CI 1.40 to 1.59) ethnicities, living in deprived neighbourhoods (OR 1.64, 95% CI 1.55 to 1.73) showed higher odds of recorded pain. Patients with severe mental illnesses were found to be less likely to report pain (OR 0.43, 95% CI 0.41 to 0.46, p<0.001). 17% of the cohort from secondary care also had records from primary care. CONCLUSION The findings of this study show sociodemographic and diagnostic differences in recorded pain. Specifically, lower documentation across certain groups indicates the need for better screening protocols and training on recognising varied pain presentations. Additionally, targeting improved detection of pain for minority and disadvantaged groups by care providers can promote health equity.
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Affiliation(s)
- Jaya Chaturvedi
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Robert Stewart
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mark Ashworth
- School of Population Health & Environmental Sciences, King's College, London, UK
| | - Angus Roberts
- Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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De La Rosa JS, Brady BR, Ibrahim MM, Herder KE, Wallace JS, Padilla AR, Vanderah TW. Co-occurrence of chronic pain and anxiety/depression symptoms in U.S. adults: prevalence, functional impacts, and opportunities. Pain 2024; 165:666-673. [PMID: 37733475 PMCID: PMC10859853 DOI: 10.1097/j.pain.0000000000003056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023]
Abstract
ABSTRACT Co-occurrence of chronic pain and clinically significant symptoms of anxiety and/or depression is regularly noted in the literature. Yet, little is known empirically about population prevalence of co-occurring symptoms, nor whether people with co-occurring symptoms constitute a distinct subpopulation within US adults living with chronic pain or US adults living with anxiety and/or depression symptoms (A/D). To address this gap, this study analyzes data from the 2019 National Health Interview Survey, a representative annual survey of self-reported health status and treatment use in the United States (n = 31,997). Approximately 12 million US adults, or 4.9% of the adult population, have co-occurring chronic pain and A/D symptoms. Unremitted A/D symptoms co-occurred in 23.9% of US adults with chronic pain, compared with an A/D prevalence of 4.9% among those without chronic pain. Conversely, chronic pain co-occurred in the majority (55.6%) of US adults with unremitted A/D symptoms, compared with a chronic pain prevalence of 17.1% among those without A/D symptoms. The likelihood of experiencing functional limitations in daily life was highest among those experiencing co-occurring symptoms, compared with those experiencing chronic pain alone or A/D symptoms alone. Among those with co-occurring symptoms, 69.4% reported that work was limited due to a health problem, 43.7% reported difficulty doing errands alone, and 55.7% reported difficulty participating in social activities. These data point to the need for targeted investment in improving functional outcomes for the nearly 1 in 20 US adults living with co-occurring chronic pain and clinically significant A/D symptoms.
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Affiliation(s)
- Jennifer S. De La Rosa
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
| | - Benjamin R. Brady
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Arizona Center for Rural Health, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
- School of Interdisciplinary Health Programs, College of Health and Human Services, Western Michigan University, Kalamazoo, MI, United States
| | - Mohab M. Ibrahim
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Anesthesiology, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Katherine E. Herder
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jessica S. Wallace
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Departments of Family and Community Medicine and
| | - Alyssa R. Padilla
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
| | - Todd W. Vanderah
- Comprehensive Pain and Addiction Center, University of Arizona Health Sciences, Tucson, AZ, United States
- Pharmacology, College of Medicine, University of Arizona, Tucson, AZ, United States
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Peltzer K. Lifestyle factors, mental health, and incident and persistent intrusive pain among ageing adults in South Africa. Scand J Pain 2023; 23:161-167. [PMID: 35467093 PMCID: PMC10249480 DOI: 10.1515/sjpain-2022-0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/13/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVES The purpose of this study was to evaluate longitudinal associations with incident and persistent intrusive pain among rural South Africans. METHODS Longitudinal data from two consecutive waves in 2014/2015 and 2018/2019 in Agincourt, South Africa, were analysed. Pain was assessed with the Brief Pain Inventory. RESULTS In all, 683 adults of 3,628 participants without intrusive pain in Wave 1 (19.1%) had incident intrusive pain in Wave 2, 94 adults of 254 participants who had intrusive pain in Wave 1 (38.3%) had intrusive pain at both Wave 1 and 2 (persistent intrusive pain). Furthermore, 358 (7.2%) participants had intrusive pain at baseline. In the fully adjusted model for people without intrusive pain at baseline, the study found that obesity (AOR: 1.31, 95% CI: 1.05-1.63), depressive symptoms (AOR: 1.67, 95% CI: 1.34-2.08), PTSD (AOR: 1.71, 95% CI: 1.19-2.45), and poor sleep quality (AOR: 1.30, 95% CI: 1.04-1.62) were positively associated with incident intrusive pain. Older age was positively, and male sex and daily alcohol use were negatively associated with incident intrusive pain. Furthermore, in the final adjusted logistic regression model, this study found that older age was positively, and underweight, overweight, and high sedentary behavior were negatively associated with persistent intrusive pain. CONCLUSIONS Several modifiable risk factors for incident and/or persistent intrusive pain were identified.
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Affiliation(s)
- Karl Peltzer
- Department of Research Administration and Development, University of Limpopo, Polokwane, South Africa; and Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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Yaman Aktaş Y, Hendekci A. A correlational study on pain and depression in geriatric patients scheduled for orthopaedic surgery. Psychogeriatrics 2022; 22:851-858. [PMID: 36114633 DOI: 10.1111/psyg.12892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/13/2022] [Accepted: 08/23/2022] [Indexed: 11/28/2022]
Abstract
AIM Pain is prevalent in geriatric patients and is not only a signal of physical diseases but also a symptom of mental health problems. This study aimed to explore the relationship between pain and depression in geriatric patients scheduled for orthopaedic surgery. METHODS The study used a correlational and cross-sectional design. The study sample consisted of geriatric patients (n = 200) scheduled for orthopaedic surgery in a research and training hospital in northern Turkey. Data were collected by the researchers using the Geriatric Pain Measure and Geriatric Depression Scale. In the data analysis, descriptive statistics, Pearson's correlation, and hierarchical regression analysis were used. RESULTS The patients' mean age was 73.16 ± 8.27 years. It was found that 5.5% (n = 11) of the participants had mild pain, 45.5% (n = 91) had moderate pain, and 49% (n = 98) had severe pain. There was a positive and moderate significant relationship between the mean Geriatric Pain Measure and Geriatric Depression Scale scores (r = 0.479, P < 0.01). Age (β = 0.133; P < 0.05) and education (β = 2.484; P < 0.05) were statistically significantly associated with depression. There was a significant and positive relationship between depression and being dependent in activities of daily living (β = 5.098; P < 0.05). CONCLUSION This study demonstrated that geriatric patients who were older, illiterate, dependent in activities of daily living, and with higher levels of pain had higher depression. A multidisciplinary team approach including nurses should be utilised in pain management and it should not be ignored that severe pain may be associated with depression in geriatric patients.
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Affiliation(s)
- Yeşim Yaman Aktaş
- Department of Surgical Nursing, the Faculty of Health Sciences, Giresun University, Giresun, Turkey
| | - Ayla Hendekci
- Department of Public Health Nursing, the Faculty of Health Sciences, Giresun University, Giresun, Turkey
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Bisby MA, Chandra SS, Dudeney J, Scott AJ, Titov N, Dear BF. Can Internet-Delivered Pain Management Programs Reduce Psychological Distress in Chronic Pain? Exploring Relationships Between Anxiety and Depression, Pain Intensity, and Disability. PAIN MEDICINE 2022; 24:538-546. [PMID: 36315066 DOI: 10.1093/pm/pnac158] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 09/29/2022] [Accepted: 10/16/2022] [Indexed: 11/18/2022]
Abstract
Abstract
Background
Adults with chronic pain who also report high pain intensity and disability are more likely to experience depression and anxiety symptoms. The present study examined changes in anxiety and depression symptoms after an Internet-delivered pain management program based on baseline pain intensity and disability severity categories.
Methods
We conducted a secondary analysis of data from four randomized controlled trials (N = 1,333).
Results
Greater pain intensity and disability were associated with increased odds of elevated anxiety or depression symptoms at baseline. Treatment led to greater reductions in anxiety and depression symptoms compared with a waitlist control, and these improvements occurred irrespective of baseline pain intensity or disability severity. Those individuals who reported ≥30% improvements in pain intensity or disability after treatment were more likely to also report ≥30% improvements in psychological symptoms. Importantly, most participants who achieved ≥30% improvements in depression and anxiety had not experienced such improvements in pain intensity or disability.
Conclusion
These findings suggest that emerging Internet-delivered pain management programs can lead to reductions in psychological distress even when pain intensity and disability are severe or do not improve with treatment. This indicates the value of such treatments in treating distress and improving mental health in people with chronic pain.
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Affiliation(s)
- Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University , Sydney, Australia
| | - Shianika S Chandra
- eCentreClinic, School of Psychological Sciences, Macquarie University , Sydney, Australia
| | - Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Macquarie University , Sydney, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Macquarie University , Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University , Sydney, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University , Sydney, Australia
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Selvamani Y, Sangani P, Muhammad T. Association of back pain with major depressive disorder among older adults in six low- and middle-income countries: A cross-sectional study. Exp Gerontol 2022; 167:111909. [PMID: 35931302 DOI: 10.1016/j.exger.2022.111909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Back pain is one of the leading causes of disability and decreased quality of life. In this study, we examined the association between back pain and major depressive disorder (MDD) in six low- and middle-income countries. We also examined the association of back pain duration and severity with MDD among middle-aged and older adults in these countries. METHODS Nationally representative data from the World Health Organization's Study on global AGEing and adult health (WHO-SAGE) consisting of 33,878 middle-aged and older adults aged 50 years or above were analysed. The linkages of back pain, pain duration and severity with MDD were examined using multivariable logistic regression analyses. RESULTS Across six countries, the prevalence of MDD was higher among middle-aged and older adults who reported back pain than those who did not report back pain (14.5 % vs 4.5 %). In the pooled data, middle-aged and older adults who suffered from back pain had higher odds of depression [adjusted odds ratio (aOR): 2.41, confidence interval (CI): 2.19-2.64] compared to those with no back pain. Particularly, the association was stronger in Ghana [aOR: 4.78] and South Africa [aOR: 2.42]. Further, the association was stronger for those who experienced back pain for >2 weeks as well as those who reported severe and extreme back pain than those with no back pain across all the countries. CONCLUSION In this study, the association of back pain and its duration and severity with MDD is consistent and significant among middle-aged and older adults in six countries. Government policies should consider the role of back pain in improving the mental health of middle-aged and older adults.
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Affiliation(s)
- Y Selvamani
- International Institute for Population Sciences, Govandi Station Road, Deonar, Maharashtra 400088 Mumbai, India.
| | - Purvi Sangani
- International Institute for Population Sciences, Govandi Station Road, Deonar, Maharashtra 400088 Mumbai, India
| | - T Muhammad
- International Institute for Population Sciences, Govandi Station Road, Deonar, Maharashtra 400088 Mumbai, India
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Muhammad T, Rashid M. Prevalence and correlates of pain and associated depression among community-dwelling older adults: Cross-sectional findings from LASI, 2017-2018. Depress Anxiety 2022; 39:163-174. [PMID: 34970825 DOI: 10.1002/da.23239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Health practitioners often meet older persons suffering both from pain and depression. The study aimed to examine the factors associated with pain among older individuals and its association with major depression. In addition, the interaction between self-rated health (SRH), wealth status, and pain that is associated with depression are explored. METHODS We used data from the Longitudinal Aging Study in India (LASI). Participants included 15,098 male and 16,366 female adults aged 60 years or older. Univariate and bivariate analyses along with χ2 tests were conducted in the initial stage. Binary logistic regression analyses were performed to fulfill the objectives. Major depression was calculated using Short Form Composite International Diagnostic Interview. RESULTS A proportion of 39.6% older individuals (n = 12,686) reported pain and 8.7% older adults (n = 2657) suffered from depression. Older adults who suffered from pain frequently were more likely to be depressed than those who never suffered from pain (adjusted odds ratio [AOR]: 1.70; confidence interval [CI]: 1.38-2.09). The interaction of pain, SRH, and household wealth status on depression found that older adults with pain who reported poor SRH (AOR: 4.18; CI: 3.50-5.00) or belonged to rich households (AOR: 2.27; CI: 1.84-2.80) had higher odds of suffering from depression, compared to older adults with no pain and good SRH or no pain and belonged to poor households. CONCLUSION It is highlighted that pain is quite common in older people, and is linked to depression especially among older people with poor SRH. Thus, routine evaluation of pain and associated symptoms of mental illnesses should be performed for ensuring healthy aging.
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Affiliation(s)
- Thalil Muhammad
- Department of Family and Generations, International Institute for Population Sciences, Mumbai, Maharashtra, India
| | - Muhammed Rashid
- Department of Rehabilitation Research, JSS College of Physiotherapy, Mysore, India
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Brooks JM, Umucu E, Storm M, Chiu C, Wu JR, Fortuna KL. Preliminary Outcomes of an Older Peer and Clinician co-Facilitated Pain Rehabilitation Intervention among Adults Aged 50 Years and Older with Comorbid Chronic Pain and Mental Health Conditions. Psychiatr Q 2021; 92:561-571. [PMID: 32827098 PMCID: PMC7897749 DOI: 10.1007/s11126-020-09831-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The present study aimed to examine the acceptability, feasibility, and preliminary effectiveness of an older peer and clinician co-facilitated Behavioral Activation for Pain Rehabilitation (BA-PR) intervention among adults aged 50 years and older with comorbid chronic pain and mental health conditions. This was a mixed-methods research design with eight participants aged 55 to 62 years old with mental health conditions including schizophrenia spectrum disorder, bipolar disorder, major depressive disorder, personality disorder, and adjustment disorder. The quantitative data were assessed from observational methods, a pain rating scale and related measures. We used semi-structured interviews for qualitative feedback on experiences with the BA-PR intervention after participation. Overall, the participants had positive experiences following receipt of the BA-PR intervention. The recruitment and adherence rates for participants were 72.7% and 100%, respectively. Approximately 75% of the participants remained enrolled in the study. Findings from a paired t-test showed the BA-PR intervention was linked to significantly reduced prescription opioid misuse risk, t (7) = 2.42, p < 0.05. There were also non-significant reductions in pain intensity and depression severity, in addition to improvements in active and passive pain coping strategies and behavioral activation.The BA-PR intervention is the first pain rehabilitation intervention specifically designed for middle-aged and older adults with comorbid chronic pain and mental health conditions. Our findings indicate promise for the BA-PR intervention to potentially reduce prescription opioid misuse risk, pain, and depressive symptoms. However, a quasi-experimental study is needed before rigorous effectiveness testing.
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Affiliation(s)
- Jessica M Brooks
- Columbia University School of Nursing, 560 West 168th Street, New York, NY, 10032, USA.
| | - Emre Umucu
- Department of Rehabilitation Sciences, University of Texas at El Paso, El Paso, TX, 79902, USA
| | - Marianne Storm
- Faculty of Health Sciences, Department of Public Health, University of Stavanger, 4036, Stavanger, Norway
| | - Chungyi Chiu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, 61820, USA
| | - Jia-Rung Wu
- Department of Counselor Education, Daniel L. Goodwin College of Education, Northeastern Illinois University, 5500 North St. Louis Avenue, Chicago, IL, 60625, USA
| | - Karen L Fortuna
- Geisel School of Medicine, Department of Mental Health, Dartmouth College, Lebanon, NH, 03766, USA.,CDC Health Promotion Research Center at Dartmouth, Lebanon, NH, 03766, USA
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Amspoker AB, Snow AL, Renn BN, Block P, Pickens S, Morgan RO, Kunik ME. Patient Versus Informal Caregiver Proxy Reports of Pain Interference in Persons With Dementia. J Appl Gerontol 2020; 40:414-422. [PMID: 32026743 DOI: 10.1177/0733464820902632] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Objectives: Pain assessment and treatment is challenging among persons with dementia (PWDs). To better understand reports of pain interference, we examined ratings made by PWDs, as well as corresponding ratings about PWDs, as reported by the caregiver. We aimed to assess alignment between and predictors of caregiver and PWD report of pain interference. Methods: The sample consisted of 203 veterans with pain and mild to moderately severe dementia and an informal caregiver. Results: Most PWDs and their caregivers reported at least some pain interference and similar levels of pain interference. PWDs with greater cognitive impairment reported less pain interference, whereas caregivers who perceived the PWD to have greater depression reported more pain interference. Conclusions: PWD and caregiver characteristics were differentially associated with PWD versus caregiver report of pain interference. Results suggest the importance of caregiver reports to inform assessment, as well as factors complicating assessment. Pain in Dementia As one ages, the risk of developing both dementia and pain increases substantially (Scherder et al., 2009). It is estimated that 30% to 50% of persons with dementia (PWDs) experience persistent pain, a complex multifactor problem (Corbett et al., 2014). Despite the high prevalence of pain among older adults with dementia, and major advances in pain management, pain often remains unrecognized or undertreated (Hodgson et al., 2014).
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Affiliation(s)
- Amber B Amspoker
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - A Lynn Snow
- The University of Alabama, Tuscaloosa, USA.,Tuscaloosa VA Medical Center, AL, USA
| | | | | | - Sabrina Pickens
- The University of Texas Health Science Center at Houston, USA
| | - Robert O Morgan
- The University of Texas School of Public Health, Houston, USA
| | - Mark E Kunik
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, TX, USA.,Baylor College of Medicine, Houston, TX, USA.,VA South Central Mental Illness Research, Education and Clinical Center, Houston, TX, USA
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Self-Reported Pain Intensity and Depressive Symptoms Among Community-Dwelling Older Adults with Schizophrenia Spectrum Disorders. Community Ment Health J 2019; 55:1298-1304. [PMID: 31098766 PMCID: PMC7053180 DOI: 10.1007/s10597-019-00403-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/06/2019] [Indexed: 12/28/2022]
Abstract
Older adults with schizophrenia have some of the highest rates of both medical and psychiatric comorbidities. Despite this, little is known about comorbid pain and depressive symptoms in schizophrenia research. This study aimed to examine the associations between levels of pain intensity and depressive symptoms among community-dwelling adults aged 50 years and older with schizophrenia spectrum disorders. Recruited from U.S. community mental health centers, participants reported on pain and depressive symptoms at the onset of the Helping Older People Experience Success (HOPES) study. Unadjusted and adjusted regression analyses were conducted. Higher pain intensity was associated with elevated depressive symptoms in all analyses, which is consistent with other studies in the general population. Given the widespread efforts to manage pain and related mental health complications in older adults without serious mental illnesses, it is likewise important that community-based mental health professionals monitor and address intense pain and related depressive symptoms among older adults with schizophrenia.
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Salman Roghani R, Delbari A, Asadi-Lari M, Rashedi V, Lökk J. Neuropathic Pain Prevalence of Older Adults in an Urban Area of Iran: A Population-Based Study. PAIN RESEARCH AND TREATMENT 2019; 2019:9015695. [PMID: 30719350 PMCID: PMC6334371 DOI: 10.1155/2019/9015695] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 11/02/2018] [Accepted: 11/22/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pain prevalence would increase as the population grows older, but the exact prevalence rate is not apparent in Iran. OBJECTIVES This study, therefore, set out to reveal the prevalence of pain, especially neuropathic type and explore its associated comorbidities among Iranian older adults in a large urban population-based survey. METHODS 5326 older people, aged ≥ 60 years, were randomly chosen by a multistage, cluster sampling method. The selected people then were interviewed by using the following instruments: a standard questionnaire about pain, questions of interview part of Douleur Neuropathique 4 Questions (DN4) and its comorbidities, GHQ-28, and a sociodemographic checklist. Descriptive statistics and multiple regression analysis were conducted to analyze the gathered data. RESULTS The average of the participants' age was 68.92 ± 7.02 years. Of 5326 participants, 2529 (47.5%) of participants were male. About one-third of this population had chronic pain. Chronic neuropathic pain prevalence was 13.7% and nociceptive in 30%. Knee pain (20.6%) and feet dysesthesia (7.8%) were the most common sites of nociceptive and neuropathic pain, respectively. Results of multiple regression analysis revealed that the major comorbidities of chronic pain were osteoporosis, disability, diabetes mellitus, and stroke. Neuropathic pain experiences were significantly associated with GHQ-28 scores (t=-11.42, P<0.001). CONCLUSIONS In addition to neuropathic pain, other subtypes of pain prevalence and the comorbidities are determined in the community-dwelling elder adults. This study highlights the importance of neuropathic pain and its adverse consequences and can be used to manage this populations' needs in Iran effectively.
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Affiliation(s)
- Reza Salman Roghani
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
- Physical Medicine and Rehabilitation Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ahmad Delbari
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
- Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohsen Asadi-Lari
- Department of Epidemiology, School of Public Health, Oncopathology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Rashedi
- School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Johan Lökk
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Stockholm, Sweden
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Brooks JM, Umucu E, Huck GE, Fortuna K, Sánchez J, Chiu CY, Bartels SJ. Sociodemographic characteristics, health conditions, and functional impairment among older adults with serious mental illness reporting moderate-to-severe pain. Psychiatr Rehabil J 2018; 41:224-233. [PMID: 30160508 PMCID: PMC6123826 DOI: 10.1037/prj0000316] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare adults aged ≥50 years with serious mental illness reporting moderate-to-severe pain to older adults with serious mental illness without pain with respect to sociodemographic characteristics, health conditions, and functional impairment. METHOD Secondary data analyses were conducted using baseline assessments of 183 participants recruited for the Helping Older People Experience Success (HOPES) study from three community mental health centers. The primary outcome was self-reported, nonexperimentally induced, moderate-to-severe pain (referent = no-to-mild pain). Predictor variables consisted of sociodemographic characteristics, health conditions, and functional impairment. We conducted univariable and multivariable logistic regression analyses to examine the associations between these variables. RESULTS Sixty-one participants (33.3%) from our sample reported pain. Pain was associated with all of the sociodemographic and health-related factors in univariable analyses. In the multivariable model, only older age, pain-related activity interference, and physical and emotional health-related social limitations were significantly associated with pain. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The presence of moderate-to-severe pain in older adults with serious mental illness is associated with pain-attributable impairment of activities and social problems above and beyond the substantial functional limitations routinely experienced by this high-risk, high-need group. Given the high rates of preexisting conditions and persistent social impairment among these older adults, our findings suggest that pain may contribute to worse overall functional outcomes. Future research and clinical interventions focused on improving outcomes should include an evaluation of pain as a contributor to decreased functioning and assess the need for early intervention, nonpharmacological pain management, or other health promotion services in psychiatric rehabilitation. (PsycINFO Database Record
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Affiliation(s)
- Jessica M. Brooks
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH
- University of North Texas, Denton, TX
| | - Emre Umucu
- Department of Rehabilitation Sciences, The University of Texas at El Paso, El Paso, Texas
| | - Garrett E. Huck
- Department of Rehabilitation and Human Services, Pennsylvania State University- Penn State Hazleton, Hazleton, PA
| | - Karen Fortuna
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH
| | - Jennifer Sánchez
- Department of Rehabilitation and Counselor Education, The University of Iowa, Iowa City, IA
| | - Chung-Yi Chiu
- Department of Kinesiology and Community Health, University of Illinois at Urbana Champaign, Urbana, IL
| | - Stephen J. Bartels
- Department of Psychiatry, Geisel School of Medicine and Centers for Health and Aging, Dartmouth College, Lebanon, NH
- The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH
- Centers for Health and Aging, Lebanon, NH
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