From: Are depression, anxiety and poor mental health risk factors for knee pain? A systematic review
Author (year) | Study design | Assessment of depression | Assessment of pain pain/OA | Results | Conclusion | Quality score |
---|---|---|---|---|---|---|
Creamer (1999- Baltimore study) | Cross-sectional | Arthritis Impact Measurement Scales (AIMS) Questionnaire (Depression subscale) | Pain on most days for at least one month (National Health and Nutrition Examination Survey (NHANES-1)) | Pain reporting was not related to depression (statistics not provided). | Depression was not associated with knee pain. | 55 |
Depression scores were higher in subjects reporting ‘ever’ pain in the presence of normal radiographs than in those without reported knee pain (1.70 ± 0.27 versus 1.16 ± 0.09), but this was not statistically significant (P= 0.06). | ||||||
Creamer (1999) | Cross-sectional | Centre for Epidemiological Studies Depression Scale (CES-D) | Pain Severity | Unadjusted Correlations: MPQ: r= 0.31 (p < 0.05). | There was no association between depression and pain severity after adjustment. | 55 |
(WOMAC, Visual Analogue Scale, | VAS: r= 0.19 (NS) | |||||
McGill Pain Questionnaire (MPQ)) | WOMAC: r= 0.15 (NS) | |||||
In the stepwise regression models after adjustment, depression did not remain in the model. | ||||||
Salaffi (1991) | Cross-sectional | Zung Depression Inventory | Pain | Stepwise multiple regression: | Depression was found to be associated with the pain experience. | 45 |
(McGill Pain Questionnaire (MPQ), Visual Analogue Scale (VAS)) | ||||||
MPQ: R= 0.41; t= 2.99; p < 0.01 | ||||||
VAS R= 0.39; t= 2.77; p < 0.01 | ||||||
van Baar (1998) | Cross-sectional | IRGL Questionnaire | Severity of pain: Visual Analogue Scale | Bivariate Correlation: | Depression was not associated with knee pain. | 64 |
Knee pain: r= 0.28 p ≤ 0.01 | ||||||
Regression Analysis: NS (not remain in the model) | ||||||
Wright (2008) | Cross-sectional | CES-D | WOMAC pain scale | WOMAC: mean= 17.76 ± 14.47 | There was an association between knee pain and depressive symptoms. | 82 |
Psychological Disability subscale of AIMS | ||||||
Depressive Sx: mean= 1.80 ± 2.79 | ||||||
Neuroticism: mean= 2.26 ± 0.59 | ||||||
Negative affect: mean= 1.67 ± 0.51 | ||||||
Correlation between pain and depressive Sx: r= 0.21; p < 0.01 | ||||||
Correlation between pain and negative affect: r= 0.15; p < 0.05 | ||||||
Pells (2008) | Cross-sectional | Psychological Disability subscale of AIMS | AIMS | Correlation between psychosocial disability and AIMS pain scale: r= 0.24; p < 0.01. | Pain did not demonstrate an association with psychological disability. | 64 |
Multiple regression: NS | ||||||
Peat (2009) | Nested case-controlled | Hospital Anxiety and Depression Scale | Characteristic pain intensity: Chronic Pain Grade | Mean difference (95% CI) of depression between cases and controls at 18Â months: 2.2 (1.2 to 3.1) | Substantial deterioration of knee pain is accompanied by an increase in depressive symptoms. | 79 |
Pain extent: areas of pain experienced in previous month shaded on whole-body manikin | ||||||
Cases were subjects who had mild knee pain at study entry and become severe at 18Â months follow up. | ||||||
Night pain: single item on WOMAC | Controls were subjects who still had mild knee pain at 18Â months follow up and were selected from similar cohort as cases). | |||||
Riddle (2011) | Longitudinal Cohort Study | 20-item CES-D | Knee Pain: WOMAC pain scale | dichotomised CES-D score (≥16) | Baseline depression is the most consistent psychological predictor of yearly worsening of pain. Association exists after adjusting for confounding variables. | 92 |
Disability: WOMAC disability scale | Univariate analysis: WOMAC Pain: Estimate (95% CI)= 0.36 (0.16 to 0.56); p < 0.001 | |||||
Multivariate analysis: WOMAC Pain: Estimate (95% CI)= 0.59 (0.18 to 1.01); p= 0.005 | ||||||
Chappell | Randomised Controlled Trial(RCT) investigating the effect of antidepressant (Duloxetine) on knee OA | Beck Depression Inventory-II (BDI-II) Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) | Knee Pain: Brief Pain Inventory (BPI); WOMAC pain and stiffness subscales Perceived improvement: Clinical Global Impressions of Severity (CGI-S) | Mean change in pain score from baseline (at 13Â weeks) | Treatment with duloxetine 60 to 120Â mg was associated with significant pain reduction in patients with pain due to knee OA. | 8* |
(USA, 2011) | ||||||
BPI average pain (% response) | ||||||
≥30%= 65.3 (antidepressant group= I) & 44.1 (placebo= C); p ≤ 0.001 | ||||||
WOMAC: -13.74 (I) -17.51 (C); p ≤0.05 | ||||||
CGI-S: -0.40 (I) & -0.70(C); p ≤ 0.01 | ||||||
Chappell | RCT investigating the effect of antidepressant (Duloxetine) on knee OA | Beck Depression Inventory-II | Knee Pain: Weekly 24-h worst pain; WOMAC pain subscale | Mean change (SD) in pain score from baseline (at 13Â weeks) | Duloxetine demonstrated statistically significant pain reduction compared with placebo. | 9* |
(USA, 2009) | ||||||
Hospital Anxiety and Depression Scale (HADS) | ||||||
BPI-S(Average pain): –2.82 ±0.21(C) –1.85 ± 0.21(C); p < .001 | ||||||
Severity: BPI-S, Brief Pain Inventory-Severity; CGI-S, Clinical Global Impressions of Severity | ||||||
WOMAC: –4.64 ± 0.35 (I) | ||||||
−3.24 ± 0.35(C); p= 0.003 | ||||||
CGI-S: -0.65 ±0.08(I) & –0.29 ± 0.08(C); p= 0.001 | ||||||
Abou-Raya | RCT investigating the effect of antidepressant (Duloxetine) on knee OA | Geriatric depression scale | Knee Pain Visual analogue pain scale; WOMAC pain score | WOMAC pain score | Duloxetine has a dual beneficial effect of improving depression and pain symptoms in older adults with knee OA. | 10* |
(Egypt, 2012) | (0–20): Mean (SD) | |||||
At baseline: Intervention - 9.1(4.6) | ||||||
Placebo - 8.9(5.1); p= 0.44 | ||||||
At 16 weeks : Intervention - 6.0 (4.1) Placebo - 8.4 (5.4); p= 0.05 |