Focusing on depressive symptoms in patients to mitigate the risk of pain: a nationwide, prospective cohort study.

BACKGROUND

Depressive symptoms and pain frequently coexist and contribute substantially to individual and public health burdens. Although previous studies have demonstrated a bidirectional relationship between depressive symptoms and pain, several important knowledge gaps remain. Most investigations have focused on overall pain burden or specific pain conditions, limiting understanding of whether depressive symptoms are associated with the risk of pain across different anatomical sites. In addition, the dose-response relationship between depressive symptom severity and subsequent pain risk remains poorly characterized, particularly in nationally representative Chinese populations.

METHODS

The China Health and Retirement Longitudinal Study (CHARLS), a national, multi-center, prospective cohort study initiated in 2011, enrolled 6,772 participants for the final analysis, based on specific inclusion and exclusion criteria. Depressive symptoms was defined as a Center for Epidemiologic Studies Short Depression (CESD) score ≥ 10. To investigate potential associations between depressive symptoms, CESD scores, and 15 distinct types of pain, Cox proportional hazards models were employed, with restricted cubic splines (RCS) applied to examine non-linear relationships. Lastly, subgroup analyses were performed to substantiate the reliability of the findings further.

RESULTS

In the fully adjusted model, individuals with depressive symptoms exhibited a significantly higher risk of experiencing pain in specific body regions compared to their non-depressed counterparts. Furthermore, for every 1 standard deviation increase in CESD score, the risk of pain in certain body areas rose by 4%-7%. Moreover, CESD scores displayed a distinct S-shaped non-linear relationship with ten types of pain, including headache and shoulder ache. Additionally, in the majority of subgroups, both depressive symptoms and CESD scores were positively correlated with pain risk, aligning with the overall findings of the study.

CONCLUSIONS

In the Chinese population, depressive symptoms and CESD scores represent significant potential risk factors for pain.