Pain Worsens Physical and Financial Burdens for Adults with Depression Nearing Retirement, Six-Year Study Shows Results Call for Better Pain Diagnosis and Treatment Strategies INDIANAPOLIS, May 2 /PRNewswire-FirstCall/ -- When depression and pain occur together, people nearing retirement (aged 50 to 61) suffer much larger increases in medical costs and limitations in their ability to work and perform daily activities than individuals with depression alone, according to a six-year study published in a recent issue of Psychiatric Services. The joint occurrence of depression and pain was as common as depression alone in this group, but outcomes were significantly worse. At baseline, two out of three individuals with depression and mild or moderate pain reported limitations in their ability to work, increasing to nine out of 10 among those with more severe pain. In contrast, only one out of four individuals with depression alone reported similar limitations. Paralleling this, respondents with depression and co-morbid pain were much less likely to be employed (21 percent with severe pain, 38 percent with mild to moderate pain) than respondents with depression alone (54 percent). Similar differences existed for private insurance. Individuals with depression and pain spent $14,000 to $25,000 more in average total healthcare costs than those with depression alone. They also had increasing difficulties in performing physical activities, such as bathing, eating, dressing, walking across a room and getting into or out of bed. The difference to individuals with depression only widened over time. "We have seen increased awareness of the social consequences of depression, but this study makes the case for more education about the impact pain has when it occurs simultaneously with depression," said Roland Sturm, PhD, RAND Corporation, a nonprofit research organization. "Individuals with depression and pain were also more likely to remain chronically depressed than those without pain." Co-morbid pain occurs frequently in patients with clinically significant depressive symptoms, often complicating both the recognition and treatment of depression(i). Individuals with these conditions are significantly less likely to receive mental health specialty care, often seeking complementary and alternative treatments with questionable effectiveness(ii). "Patients should be assessed for both depression and pain. If both are present but only one treated, outcomes may be compromised," said Rebecca Robinson, MS, health outcomes researcher, Eli Lilly and Company. "Respondents with depression and severe pain may be particularly vulnerable to limited access to adequate treatment for their mental illness due to higher rates of unemployment and less of private insurance." Methods Researchers analyzed the health status of participants in the national Health and Retirement Study (HRS) from 1994 to 2000. HRS was a longitudinal national survey initiated in 1992 to track national trends in health and economic wellbeing among retired and near-retired Americans. Mental health status was measured consistently from 1994 using an eight-item version of the depression scale developed by the Center for Epidemiologic Studies (CES-D). Participants were surveyed every two years. In 1994, 8,807 individuals responded, followed by 7,992 subjects in 2000, an overall retention rate of 76.3 percent. Respondents were also asked whether they often experienced pain, without reference to a physical cause. Responses were categorized into no pain, mild/moderate pain and severe pain. Pain and depression results were interpreted using six-levels of classification that distinguished all of the possible pain-depression combinations. Researchers also controlled for the presence of physician-diagnosed diabetes, hypertension, cancer, stroke, heart disease, lung disease and arthritis. Limitations The study has typical limitations of large observational studies. The assessment of mental health is not based on a clinical diagnosis. Measurement error on the CES-D scale could have created bias in these co-efficient estimates. The measurements of pain are limited and may reflect other unmeasured chronic conditions. Although attrition was small for this type of survey and there was little mortality, the possibility of bias cannot be excluded. Because of the limited age range, it is unclear whether the results generalize to elderly or younger populations. About Lilly Lilly, a leading innovation-driven corporation, is developing a growing portfolio of first-in-class and best-in-class pharmaceutical products by applying the latest research from its own worldwide laboratories and from collaborations with eminent scientific organizations. Headquartered in Indianapolis, Ind., Lilly provides answers -- through medicines and information -- for some of the world's most urgent medical needs. Additional information about Lilly is available at http://www.lilly.com/. P-LLY (i) Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and Pain Comorbidity: A literature review. Arch Int Med 2003;163:2433-2445 (ii) Bao Y, Sturm R, Croghan TW. How does chronic pain impact health care utilization by depressed individuals? A national study. Psychiatric Services 54:693-697, 2003. (Logo: http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO ) http://www.newscom.com/cgi-bin/prnh/20031219/LLYLOGO DATASOURCE: Eli Lilly and Company CONTACT: David Shaffer, +1-317-651-3710, pager: +1-877-656-9084 (US), or Jennifer Yoder, +1-317-433-3445, pager: +1-888-274-0289 (OUS), both of Eli Lilly and Company

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