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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 19  |  Issue : 1  |  Page : 42-46

Chronic pain and psychological distress among adults in Udupi


1 Department of Public Health, Manipal University, Manipal, Karnataka, India
2 Department of Clinical Psychology, Government College, Bhawanipatna, Odisha, India

Date of Web Publication26-Jun-2018

Correspondence Address:
Mr. Paramjot Panda
Department of Public Health, Manipal University, Manipal, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AMH.AMH_11_18

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  Abstract 


Background: Depression is an important public health problem and one of the leading causes of disease burden worldwide. Depression is often comorbid with other chronic diseases and can worsen their associated health outcomes. Few studies have explored the effect of depression alone or as comorbidity, with chronic pain.
Objective: The objective of this study was to study the prevalence and pattern of sociodemographic characteristics of persons with depression and chronic pain residing in the Udupi taluk, Karnataka, India.
Methodology: This cross-sectional study included 360 participants of above 18 years of age. The participants were recruited using simple random sampling technique from January 2017 to June 2017. Descriptive and analytical methods were used to estimate the prevalence and to identify the associated disorders.
Results: It was observed during the study that prevalence of psychological distress (PD) was (58.88%). Majority of the females had moderate-to-severe PD (55.66%). The age group of 35–50 years (36.97%) had moderate-to-severe PD. The other psychiatric disorder associated with chronic pain was somatic dysfunction (27.8%), anxiety (26.9%), social dysfunction (33.8%), and depression in (11.5%).
Conclusion: Depression produces the greatest decrement in health compared to the chronic physical disease. These results indicate the urgency of addressing depression as a public health priority to reduce disease burden and disability and to improve the overall health of populations.

Keywords: Adults, chronic pain, cross-sectional, risk factors


How to cite this article:
Panda P, Panda S. Chronic pain and psychological distress among adults in Udupi. Arch Ment Health 2018;19:42-6

How to cite this URL:
Panda P, Panda S. Chronic pain and psychological distress among adults in Udupi. Arch Ment Health [serial online] 2018 [cited 2018 Dec 14];19:42-6. Available from: http://www.amhonline.org/text.asp?2018/19/1/42/235315




  Introduction Top


Psychological distress (PD) is a major global public health issue, both because of the relatively high prevalence ranging from 2% to 15% and because it is associated with substantial disability.[1] Rated as the fourth leading cause of disease burden in 2000, PD accounted for 4.4% of total disability-adjusted life years.[2] It is also responsible for the most significant proportion of disease burden attributable to nonfatal health outcomes, which account for almost 12% of total years lived with disability worldwide.[3] Without treatment, PD has the tendency to assume as a chronic course. Furthermore, recurrent PD is to be associated with increasing disability.[4],[5] The comorbidity of PD with chronic physical diseases (CPD) such as arthritis and diabetes is well recognized in developed countries.[6],[7] Numerous epidemiological studies have shown that there is an increased risk of having major PD in people with one or more chronic diseases.[8],[9] PD is more prevalent in chronic pain patients (CPPs) than in the general population as a consequence of the presence of chronic pain. The degree to which these state of comorbid exist at the Asia-specific region and in India has not been reported. According to studies, 2%–4% of persons in the community, 5%–10% of primary care patients, and 10%–14% of medical inpatients suffer from major PD.[8] Studies done in primary care setup in India, however, have estimated the prevalence rate of depression as high as 21%–40%. Furthermore, with a growing adult population, and the associated increase in the prevalence of chronic medical conditions, a concomitant rise in the incidence of PD is to be expected.[9] In fact, projections indicate that after heart disease, PD is predictable to become the second foremost cause of disease burden by the year 2020.[10] The increasing prevalence of CPD and PD leads to the question of how these disorders compare regarding their effect on overall individual health. The presence of self-reported CPD such as angina, arthritis, asthma, and diabetes has been associated with reduced health-related quality of life scores.[11],[12],[13] Lower health status has been reported in depression patients than in those without depression, and this state is unequally distributed across population groups.[8],[14] Effects of PD have also been studied about a loss of productivity and reduced health-related quality of life. Despite this evidence, PD, such as other mental disorders, is often not deemed to be on a par with other chronic physical health conditions regarding its effect on overall health.[15] This understanding is perhaps one of the underlying reasons behind the lack of parity between mental and physical disorders regarding access to health care. The present population study attempts to study sociodemographic characteristics of PD in persons with chronic pain in general population through door-to-door survey in Udupi, Karnataka.


  Methodology Top


Study design, settings, and eligibility criteria for selecting participants

A community-based cross-sectional study was conducted among randomly selected adult dwellers of Udupi Taluk in Udupi district of Karnataka, India. Participants of age range from 18 to 60 years were recruited from January 2017 to June 2017.

Data collection methods

A semi-structured questionnaire from survey of chronic pain in Europe and community-oriented program for control of rheumatic disease questionnaire was used for data collection. The tool was modified and validated by the experts in the field for use of the tool in the Indian setting. The questionnaire had domains such as sociodemographic characteristics and chronic pain assessment. The PD among chronic pain individual was assessed using the General Health Questionnaire (GHQ) (28), which is a standardized questionnaire used to assess the PD. It contains 28 items from the original GHQ-28, across all dimensions and comprises domains such as somatic dysfunction, anxiety, social dysfunction, and depression which were used to collect the data.

Sampling technique and sample size

Single-stage cluster sampling technique was used in the study by considering each ward of Udupi taluk as a cluster. The list of wards (35 in number) which were procured from Udupi city municipal council was used as the sampling frame. A sample of each ward was obtained through probability proportionate to sampling (PPS) to sample size. Using PPS technique, the total number of participants from each ward was selected. The present study included participants of all proportion of specific age range from 18 to 60 until the desired sample size was obtained. A total of 360 participants were included in the study.

Analysis

The IBM, Version 16.0. Chicago, Statistical Package for Social Sciences SPSS Inc. for Windows was used to analyze the data. Through descriptive statistics, sociodemographics were expressed as frequencies and percentages.


  Results Top


The present study was conducted among 360 randomly selected adult's dwellers of urban Udupi taluk.

[Table 1] describes the sociodemographic characteristics of the participants. Majority of the participants (31.6%) belonged to 51–60 years of age group. The number of participants was equal among males and females. Most of the study participants were Hindus (68.1%), almost 81.4% were currently married, 35.8% had primary school education, and more than half of the study participants (55.3%) belonged to the annual income category of Rs. 50,000 to Rs. 100,000. The major two sites of pain reported by males were knees (43.2%) and low back (33.6%), whereas females reported pain at the following sites such as low back (34.3%), wrist (29.3%), and knees (29.3%). The prevalence of PD was found to be 58.88% as depicted in [Table 2].
Table 1: Sociodemographic characteristics of the study participants (n=360)

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Table 2: Prevalence of psychological distress

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In addition, females were more prone to PD as depicted in [Table 3].
Table 3: Association between psychological distress and gender

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Furthermore, other psychological disorders associated with chronic pain and most of the participants were having social dysfunction 72 (33.8%) as depicted in [Figure 1].
Figure 1: Psychiatric disorders coexist with chronic pain

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  Discussion Top


The range of pain experiences is wide and diverse. An individual's response to chronic pain reflects characteristics of the pain and the person's thoughts and behavior developed during the sequence of the sickness, which are subject to positive and negative reinforcement.[16] Major depression is the most common mental illness associated with chronic pain.[17] Hence, the present study was carried out using household survey in Udupi, Karnataka, to see the relationship between chronic pain and depression in general population. Chronic pain is a common experience and is a source of economic burden for the society. Global prevalence rates of chronic pain (International Association of Study Pain criteria specifies the duration of at least 6 months) range from 11.5% to 55.2%,[18] with a weighted mean prevalence of 35.5% across the nation.[19] The present study reported PD among the study patients with chronic pain which was 58.8%. Another study indicated that 30% of patients had the major depressive syndrome and 70.1% of suicidal thoughts among individuals with chronic pain in a clinic in Tamil Nadu. These patients were dependent on medications and on caregivers contributing to the development of behavioral patterns of general inactiveness. Thus, due to these inter-related factors, CPPs were subjected to disabilities.[20]

In addition to the negative psychological and physiological effects, pain if not managed properly can impose a heavy economic burden. In adding to lost productive time, chronic pain increases healthcare utilization owing to more regular primary care appointments and hospital admissions (a two-fold increase) as well as emergency department visits (a five-fold increase), as compared to individuals without chronic pain.[21] Although the high variation of chronic musculoskeletal pain is evident in different regions of the world, from the clinical chapters, it emerges clearly that the women patients have higher odds of suffering from pain and PD than men.[20],[22] Women in the present study also had a higher risk of both moderate and severe PD than men, and it is not unexpected as advancing age, coupled with menopausal decrements of bone health exacerbates pain. In India, every third woman is osteoporotic and consequently, osteoporosis-related high fracture risk, and declining bone mineral density (BMD) at forearm, neck, and lumbar spine worsen the propensity of musculoskeletal pain. It has also been substantiated by other population-based cross-sectional studies that women often have more musculoskeletal pain problems and PD than men.[19],[21]

Epidemiological studies have derived the inverse relationship between socioeconomic status, musculoskeletal pain, and PD. British cohort study had reported that the lowest social class had three-fold increased risk of widespread chronic pain associated PD in comparison to the highest social class.[23] Another study had reported that patients living in less affluent areas have higher chances of chronic widespread pain, physical disability, mental distress, and low life satisfaction in comparison to patients living in affluent areas.[24] The effect of pain on PD and vice versa was not easy to understand due to their usual coexistence and bidirectional relationship. It has been observed that pain threshold was reduced in patients having PD whereby somatic preoccupation may be the primary symptom. Almost 50% of the depressed patients suffering from depression report pain in their lifetime. In the primary care setting, the complex coexistence of pain and PD is largely overlooked, and most of the times, PD is considered as an artifact of musculoskeletal pain, which may lead to poor prognosis, misdiagnosis, and under-treatment of existing pain.[20]


  Conclusion Top


The present research revealed that majority of the participants in Udupi taluk had a higher prevalence of PD with chronic pain which was influenced by sedentary lifestyle, nature of job, depression, and poor sleep irrespective of the other risk variables. The results suggest that in primary care settings for the management of PD and pain, these significant variables may coexist, and therefore, should be identified and treated simultaneously. Patients with chronic pain had a moderate-to-severe level of PD along with other psychiatric disorder such as somatoform dysfunction, anxiety, social dysfunction, and depression which has a major impact on the individual's quality of life. The findings reinforce the importance of morbidities in adult's health as pain is the most common and neglected part of health. Morbidities need more attention to improve the well-being of individuals to aim for a healthy society for a better tomorrow.

Ethical issues

Ethical clearance for the study was obtained from the Institutional Ethics Committee (IEC), (IEC 879/2016). Participation was voluntary and informed consent was obtained from all the participants after the purpose of the study was explained to them using a participant information sheet. Confidentiality of the data was guaranteed.

Acknowledgment

The authors would like to thank all the participants who participated in this study my parents to support me. Furthermore, we would like to express our gratitude to the Department of Public Health, Manipal University, Manipal, Karnataka, India.

Financial support and sponsorship

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3]



 

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