Depression-Associated Stigma May Limit Access to Chronic Pain Care

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Depression-related stigma may contribute to poor access to depression and chronic pain treatment in the overall population.
Depression-related stigma may contribute to poor access to depression and chronic pain treatment in the overall population.

Individuals with chronic pain and comorbid depression may experience higher levels of stigma related to their conditions compared with patients with chronic pain alone, according to a study published in the Journal of Affective Disorders. Depression-related stigma may contribute to poor access to depression and chronic pain treatment in the overall population.

Investigators sought to evaluate stigma in 4 different groups: patients with depression alone (n=61), chronic pain (n=59), comorbid depression and chronic pain (n=56), and healthy controls (n=60).

Self-report questionnaires (including a stigma questionnaire) were given to study participants to evaluate stigma associated with treatment, secrecy, and experiences, in addition to self-imposed stigma and stigma arising from the public.

Participants with chronic pain and comorbid depression and patients with depression only had higher stigma scores compared with healthy controls (P <.001 and P =.002, respectively).

Patients with chronic pain and depression reported higher general self-stigma scores compared with healthy controls (P =.001) and had higher total stigma scores (P =.003), higher secrecy-associated stigma (P =.013), more stigmatizing experiences (P <.001), and greater general self-stigma (P =.002) compared with their counterparts with chronic pain alone. Participants with depression reported greater stigma vs individuals with chronic pain (P <.001).

Healthy controls were found to underestimate stigma perceived by patients with depression, but not by patients with chronic pain.

The study authors acknowledged the possibility that many of the participants in this study may have been hesitant to discuss their perceived stigma with the interviewers and had been likely to underreport issues related to their conditions. In addition, the adapted Depression Self-Stigma Scale that was used to obtain stigma scores may have introduced errors.

“Depression may affect the stigma felt by sufferers of conditions other than depression,” concluded the researchers.

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Reference

Naushad N, Dunn LB, Muñoz RF, Leykin Y. Depression increases subjective stigma of chronic pain. J Affect Disord. 2018;229:456-462.

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