Depression in Opioid-dependent Chronic Pain Patients in Rural Texas: A Complex Relationship

Background and/or Objectives: Chronic pain and depression are frequently cited as two of the most common causes for seeing a primary care provider. The link between pain, depression, and opioid use has an interdependent relationship that has measurable effects on patient care. Rural patients are often more susceptible to the challenges of managing chronic pain and depression. The goal of this study is to evaluate multiple factors of depression and treatment in chronic pain patients using long term opioids amongst three different rural Texas populations.

Design: A survey and Patient Health Questionnaire-9 scoring (PHQ9) questionnaire were self-completed by each participant. In total, 107 people enrolled in the study. After reviewing data, 27 (25.2%) incomplete surveys were excluded, leaving a total of 80 surveys for analysis.

Setting: Outpatient family medicine clinics in Graham, Athens, and Andrews, Texas.

Participants: Adults aged 18+ who have used opioid pain medication for greater than three months.

Interventions: not applicable

Main Outcome Measures: PHQ9 depression screening, demographics including sex and age, pain levels, and risk factors for clinical depression.

Results: Depression, as diagnosed by PHQ9, was identified in 45 (56.3%) of participants. Significant risk factors for clinical depression among study participants included family history of substance abuse (OR=23.67, p=0.008), personal history of depression (OR=6.86, p< 0.001) and previous session with a counselor or therapist (OR=2.76, p=0.035). The severity of depression in study participants was significantly associated with family history of substance abuse (p < 0.001), personal history of depression (p < 0.001), current use of an SSRI (p < 0.001).

Conclusions: The results of this study suggests a high burden of depression among study participants and enhances our understanding of the risk factors for depression among chronic pain patients in these communities. The data further emphasizes the need for proper depression screening and treatment for individuals with chronic pain and opioid use.