Depression, Depressive Somatic or Nonsomatic Symptoms, and Function in a Primarily Hispanic Chronic Pain Population

Chronic pain and depression are two major causes of disability. Comorbidity decreases psychosocial and physical functioning while increasing economic burden. The prevailing belief that Hispanics somaticize depression may hinder the diagnostic process and, thus, may impact outcomes. The purpose of this study was to explore the relationships among depression and depressive symptoms (somatic or nonsomatic) and function in chronic pain sufferers residing along the USA-Mexico border. Like other studies, as level of depression increased, level of pain increased and level of functioning decreased. So much so that almost a quarter of the participants reported moderate-to-severe depression, and another quarter of the participants reported suicidal ideation independent of depression or treatment. Unlike other published reports, we used a sample of chronic pain patients who received individualized, multimodal pain treatment. Compared to our previous work in a similar population, pain intensity and suicidal ideation were lower in this study. A plausible explanation is the use of antidepressants as adjuvant treatment for pain. Regardless of gender or ethnicity, persons with chronic pain will disclose symptoms of depression when appropriate tools are used to collect the data. Implications for future research and clinical practice are discussed. 1. Introduction Chronic pain and depression are similar in many ways. These conditions share common neurological pathways [1–3] and remain underdiagnosed and undertreated leading to decreased functioning and poor clinical outcomes [4]. As contested illnesses, they defy the mind-body dualism present in allopathic medicine, lack visible pathology and are subjective in nature [5–7]. Often invisible pathology and subjective complaints are delegitimized [8, 9] leaving individuals feeling stigmatized [6, 10–12]. Consequences of both conditions include intra- and interpersonal conflicts, cognitive complaints, social impairment, and financial distress [2, 13]. Furthermore, disability and economic burden in terms of healthcare costs and lost productivity are additive with comorbidity [4, 14]. Depressive symptoms may be masked or overlooked when the reason for a health care visit is chronic pain, especially if a depressed individual presents with somatic (physical) symptoms. Diagnosis of comorbid depression may be impacted by a prevailing, perhaps unfounded, belief that Hispanics tend to somaticize depression [15–18], that is, express mental distress as physical complaints [19, 20] and, therefore, are more likely to seek healthcare for