The relationship of chronic pain to depression, marital adjustment, and family dynamics

Abstract

Thirteen patients with depression and persistent pain (DP group) were compared with thirteen matched controls with depression and no pain (D group). The DP group was significantly more depressed in terms of both the Beck and Zung depression scales (P < 0.001). The DP group had significantly more evidence than the D group of past pain problems (P < 0.001), pain problems in the spouses (P < 0.05), pain problems in families of patients (P < 0.001), pain problems in families of spouses (P < 0.02), consistency of pain locations between patients and their spouses (P < 0.10) and between patients and spouses' family (P < 0.02). Patients and their spouses completed a marital adjustment test [11] on which the DP group showed increased marital maladjustment (P < 0.001). These findings provide evidence that depressed patients with primary pain complaints are a nosologically distinct sub-group of depressive illness. This is in accordance with some previous research but suggests that family dynamics play a greater role in pain tolerance, pain expression, complaints of pain and illness behaviour than previously indicated. The differential effects of genetic factors and family dynamics remain to be explored. Finally, the study confirms previous work suggesting a strong correlation between marital maladjustment and somatic presentations in depression. The assessment of depressed patients with primary pain complaints should include marital and family evaluation.