Research Article| Volume 56, ISSUE 7, P651-658, July 2003

Factors associated with the onset of an episode of depressive symptoms in the general population

  • Linda J Carroll
    Corresponding author. 3080 RTF, 8308-114 Street, Edmonton, AB, Canada T6G 2E1. Tel.: 780-492-9767; fax: 780-492-6328.
    Epidemiology Program and Alberta Centre for Injury Control and Research, Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada
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  • J.David Cassidy
    Epidemiology Program and Alberta Centre for Injury Control and Research, Department of Public Health Sciences, University of Alberta, Edmonton, Alberta, Canada

    Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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  • Pierre Côté
    Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada

    Institute for Work & Health, Toronto, Ontario, Canada
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      Objectives: To determined the association between spinal pain, headache, health, demographic and socio-economic characteristics, and development of depressive symptomatology.
      Methods: A population-based, random sample of adults was surveyed and followed at 6 and 12 months. Individuals at risk of depression at baseline are the subjects of this article (n = 845). We used Cox proportional hazards models to measure the time-varying effects of demographic, socio-economic, and health status; comorbid medical conditions; spinal pain; and headaches on the development of depression.
      Results: After adjusting for baseline depressive symptoms and factors associated with nonresponse to follow-up, we found that spinal pain severity, younger age, marital status (separated/divorced/widowed), self-perceived poor health status, and comorbid neurologic and gastro-intestinal disease were associated with onset of a new episode of depression.
      Conclusions: Important predictors of depressive symptomatology include demographic characteristics, health problems, and pain problems.


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        • Broadhead W.E
        • Blazer D.G
        • George L.K
        • et al.
        Depression, disability days and days lost from work in a prospective epidemiologic survey.
        JAMA. 1990; 264: 2524-2528
        • Johnson J
        • Weissman M.M
        • Klerman G.L
        Service utilization and social morbidity associated with depressive symptoms in the community.
        JAMA. 1992; 267: 1478-1483
        • Leon A.C
        • Walkup J.T
        • Portera L
        Assessment and treatment of depression in disability claimants: a cost benefit simulation study.
        J Nerv Ment Dis. 2002; 190: 3-9
        • Conner K.R
        • Duberstein P.R
        • Conwell Y
        • et al.
        Psychological vulnerability to completed suicide: a review of empirical studies.
        Suicide Life Treat Behav. 2001; 31: 367-385
        • Carroll L.J
        • Cassidy J.D
        • Côté P
        The Saskatchewan Health and Back Pain Survey: the prevalence of depressive symptomatology and its association with pain in Saskatchewan adults.
        Can J Public Health. 2000; 91: 459-464
        • Roberts R.E
        • Vernon S.W
        The Centre for Epidemiologic Studies Depression Scale: its use in a community sample.
        Am J Psychiatry. 1983; 140: 41-46
        • Anthony J.C
        • Petronis K.R
        Suspected risk factors for depression among adults 18–44 years old.
        Epidemiology. 1991; 2: 123-132
        • Coryell W
        • Endicott J
        • Keller M
        Major depression in a nonclinical sample: demographic and clinical risk factors for first onset.
        Arch Gen Psychiatry. 1992; 49: 117-125
        • Henderson J.G
        • Pollard C.A
        Prevalence of various depressive symptoms in a sample of the general population.
        Psychol Rep. 1992; 71: 208-210
        • Horwath E
        • Johnson J
        • Klerman G.L
        • et al.
        Depressive symptoms as relative and attributable risk factors for first-onset major depression.
        Arch Gen Psychiatry. 1992; 49: 817-823
        • Kessler R.C
        • Foster C
        • Webster P.S
        • et al.
        The relationship between age and depressive symptoms in two national surveys.
        Psychol Aging. 1992; 7: 119-126
        • Beck D.A
        • Koenig H.G
        Minor depression: a review of the literature.
        Int J Psychiatry Med. 1996; 26: 177-209
        • Joffe R.T
        • Lippert G.P
        • Gray T.A
        • et al.
        Mood disorder and multiple sclerosis.
        Arch Neurol. 1987; 44: 376-378
        • Starkstein S.E
        • Preziosi T.J
        • Bolduc P.L
        • et al.
        Depression in Parkinson's disease.
        J Nerv Ment Dis. 1990; 178: 27-31
      1. Plumb MM, Holland J. Comparative studies of psychological function in patients with advanced cancer: II. Interviewer-rated current and past psychological symptoms. Psychosom Med 43;243–54.

        • Hochstrasser B
        • Angst J
        The Zurich Study:.
        Eur Arch Psychiatry Clin Neurosci. 1996; 246: 261-272
        • Turner R.J
        • Beiser M
        Major depression and depressive symptomatology among the physically disabled: assessing the role of chronic stress.
        J Nerv Mental Dis. 1990; 178: 343-350
        • Linton S.F
        • Skevington S.M
        Psychological factors.
        in: Crombie I.K Croft P.R Linton S.J LeResche L Von Korff M Epidemiology of pain. IASP Press, Seattle1999: 235-255
        • Lindsay P.G
        • Wyckoff M
        The depression-pain syndrome and its response to antidepressants.
        Psychosomatics. 1981; 22: 571-577
        • Turner J.A
        • Romano J.M
        Self-report screening measures for depression in chronic pain patients.
        J Clin Psychol. 1984; 40: 909-913
        • France R.D
        • Houpt J.L
        • Skott A
        • et al.
        Depression as a psychopathological disorder in chronic low back pain patients.
        J Psychosom Res. 1986; 30: 127-133
        • Love A.W
        Depression in chronic low back pain patients: diagnostic efficiency of three self-report questionnaires.
        J Clin Psychol. 1987; 43: 84-89
        • Sullivan M.J.L
        • D'Eon J
        Relation between catastrophizing and depression in chronic pain patients.
        J Abnorm Psychol. 1990; 99: 260-263
        • Herr K.A
        • Mobily P.R
        • Smith C
        Depression and the experience of chronic back pain: a study of related variables and age differences.
        Clin J Pain. 1993; 9: 104-114
        • Rajala U
        • Keinänen-Kiukaanniemi S
        • Uusimäki A
        • et al.
        Musculoskeletal pains and depression in a middle-aged Finnish population.
        Pain. 1995; 61: 451-457
        • Ariëns G.A.M
        • Borghouts J.A.J
        • Koes B.W
        Neck pain.
        in: Crombie I.K Croft P.R Linton S.J LeResche L Von Korff M Epidemiology of pain. IASP Press, Seattle1999: 235-255
        • Dionne C.E
        Low back pain.
        in: Crombie I.K Croft P.R Linton S.J LeResche L Von Korff M Epidemiology of pain. IASP Press, Seattle1999: 283-297
        • Cassidy J.D
        • Carroll L.J
        • Côté P
        The Saskatchewan Health and Back Pain Survey. The prevalence of low back pain and related disability in Saskatchewan adults.
        Spine. 1998; 23: 1860-1867
        • Côté P
        • Cassidy J.D
        • Carroll L.J
        The Saskatchewan Health and Back Pain Survey: The prevalence of neck pain and related disability in Saskatchewan adults.
        Spine. 1998; 23: 1689-1698
        • Atkinson J.H
        • Slater M.A
        • Patterson T.L
        • et al.
        Prevalence, onset, and risk of psychiatric disorders in men with chronic low back pain: a controlled study.
        Pain. 1991; 45: 111-121
        • Brown G.K
        A causal analysis of chronic pain and depression.
        J Abnorm Psychol. 1990; 99: 127-137
        • Skevington S.M
        The relationship between pain and depression: a longitudinal study of early synovitis.
        in: Gebhart G.F Hammond D.L Jensen T.S Proceedings of the 7th World Congress on Pain. Progress in Pain Research and Management. vol. 2. IASP Press, Seattle1994: 201-210
        • Magni G
        • Moreschi C
        • Luchini S.R
        • et al.
        Prospective study on the relationship between depressive symptoms and chronic musculoskeletal pain.
        Pain. 1994; 56: 289-297
        • Von Korff M
        • Ormel J
        • Katon W
        • et al.
        Disability and depression in medical patients: a longitudinal analysis.
        Arch Gen Psychiatry. 1992; 49: 91-100
        • Von Korff M
        • Deyo R.A
        • Cherkin D
        • et al.
        Back pain in primary care: outcomes at one year.
        Spine. 1993; 18: 855-862
        • Tenant A
        • Badley E.M
        A confidence interval approach to investigating nonresponse bias and monitoring response to postal questionnaires.
        J Epidemiol Community Health. 1991; 47: 15-29
        • Ware J.E
        • Snow K.K
        • Kosinski M
        • et al.
        SF-36 Health Survey: manual and interpretation guide.
        The Health Institute, New England Medical Centre, Boston1993
        • Brazier J.E
        • Harper R
        • Jones N.M.B
        • et al.
        Validating the SF-36 Health Survey questionnaire: new outcome measure for primary care.
        BMJ. 1992; 305: 160-164
        • Kravitz R.L
        • Greenfield S
        • Rogers W.H
        • et al.
        Differences in the mix of patients among medical specialties and symptoms of care: results from the Medical Outcomes Study.
        JAMA. 1992; 267: 1617-1623
        • Kurtin P.S
        • Davie A.R
        • Meyer K.B
        • et al.
        Patient-based health status measures in outpatient dialysis: early experiences in developing an outcomes assessment program.
        Med Care. 1992; 30: MS136-MS149
        • McHorney C.A
        • Ware J.E
        • Rogers W
        • et al.
        The validity and relative precision of MOS Short- and Long-Form Health status Scales and Dartmouth COOP Charts.
        Medical Care. 1992; 20: 253-265
        • Fryback D.G
        • Dasbach E.J
        • Klein R
        • et al.
        The Beaver Dam health outcomes study: initial catalog of health state quality factors.
        Med Decis Making. 1993; 13: 89-102
        • Garratt A.M
        • Ruta D.A
        • Abdalla M.I
        • et al.
        The SF-36 Health Survey questionnaire: an outcome measure suitable for routine use within the NHS?.
        BMJ. 1993; 306: 1440-1444
        • Jenkinson C
        • Coulter A
        • Wright L
        Short form 36 (SF-36) Health Survey questionnaire: normative data for adults of working age.
        BMJ. 1993; 306: 1437-1440
        • Greenfield S
        • Sullivan L
        • Dukes K.A
        • et al.
        Development and testing of a new measure of case mix for use in office practice.
        Med Care. 1995; 33: AS47-AS55
        • Jaroszynski G
        • Cassidy J.D
        • Carroll L
        • et al.
        Development and validation of a comorbidity scale.
        Canadian Orthopaedic Research Association, Quebec City1996
        • Côté P
        • Cassidy J
        • Carroll L
        Is lifetime history of neck injury in a traffic collision associated with prevalent neck pain, headache and depressive symptomatology?.
        Accid Anal Prev. 2000; 32: 151-159
        • Côté P
        • Cassidy J
        • Carroll L
        The factors associated with neck pain and its related disability in the Saskatchewan population.
        Spine. 2000; 25: 1109-1117
        • Mercado A.C
        • Carroll L
        • Cassidy J.D
        • et al.
        Coping with neck and low back pain in the general population.
        Health Psychol. 2000; 19: 333-338
        • Carroll L.J
        • Mercado A
        • Cassidy J.D
        • et al.
        A population-based study of factors associated with combinations of active and passive coping with neck and low back pain.
        J Rehabil Med. 2002; 34: 67-72
        • Von Korff M
        • Dworkin S.F
        • LeResche L
        • et al.
        An epidemiologic comparison of pain complaints.
        Pain. 1988; 32: 173-183
        • Von Korff M
        • Dworkin S.F
        • LeResche L
        Graded chronic pain status: an epidemiologic evaluation.
        Pain. 1990; 40: 279-291
        • Von Korff M
        • Ormel J
        • Keefe F.J
        • et al.
        Grading the severity of chronic pain.
        Pain. 1992; 50: 133-149
        • Von Korff M
        • LeResche L
        • Dworkin S.F
        First onset of common pain symptoms: a prospective study of depression as a risk factor.
        Pain. 1993; 55: 251-258
        • Radloff L.S
        The CES-D Scale: a self-reported depression scale for research in the general population.
        Appl Psychol Meas. 1977; 1: 385-401
        • Weissman M.M
        • Sholomskas D
        • Pottenger M
        • et al.
        Assessing depression symptoms in five psychiatric populations: a validation study.
        Am J Epidemiol. 1977; 106: 203-214
        • Boyd J.H
        • Weissman M.M
        • Thompson W.D
        • et al.
        Screening for depression in a community sample.
        Arch Gen Psychiatry. 1982; 39: 1195-1200
        • Schulbert H.C
        • Saul M
        • McClellant M
        • et al.
        Assessing depression in primary medical and psychiatric practices.
        Arch Gen Psychiatry. 1985; 42: 1164-1170
        • Orme J.G
        • Reis J
        • Herz E.J
        Factorial and discriminant validity of the Centre for Epidemiological Studies Depression (CES-D) Scale.
        J Clin Psychol. 1986; 42: 28-33
        • Devins G.M
        • Orme C.M
        • Costello C.G
        • et al.
        Measuring depressive symptoms in illness populations: pychometric properties of the Centre for Epidemiologic Studies Depression (CES-D) Scale.
        Psychol Health. 1988; 2: 139-156
        • Blalock S.J
        • De Vellis R.F
        • Brown G.K
        • et al.
        Validity of the Center for Epidemiologic Studies Depression Scale in arthritis populations.
        Arthritis Rheum. 1989; 32: 991-997
        • Turk D.C
        • Okifuji A
        Detecting depression in chronic pain patients: adequacy of self-reports.
        Behav Res Ther. 1994; 32: 9-16
        • Cleves M.A
        • Gould W.W
        • Gutierrez R.G
        An introduction to survival analysis using STATA.
        Stata Press, College Station, Texas2002
        • Hosmer D.W
        • Lemeshow S
        Applied logistic regression.
        Wiley, New York1989
      2. SPSS for Windows, Version 11.0. SPSS Inc, Chicago2001
      3. Stata 7.0. Stata Corporation, College Station (TX)2000
        • Von Korff M
        • Simon S
        The relationship between pain and depression.
        Br J Psychiatry. 1996; 168: 101-108
        • Breslau N
        • Davis G.C
        • Schultz L.R
        • et al.
        Migraine and major depression: a longitudinal study.
        Headache. 1994; 34: 387-393
        • Breslau N
        • Davis G.C
        Migraine, major depression and panic disorder: a prospective epidemiologic study of young adults.
        Cephalalgia. 1992; 12: 85-90