Factors Associated with Depression, Anxiety, and Sleep Disturbance Among Patients with Moderate-to-Severe Chronic...

This study aimed to investigate the prevalence of depression/anxiety/sleep disturbance (D/A/S), as well as factors associated with these conditions, among patients with moderate-to-severe chronic pain.

This cross-sectional study was conducted at 13 tertiary hospitals in 10 provinces, enrolling consecutive patients with chronic pain from November 2023 to May 2024. Depression was defined using the Patient Health Questionnaire-9 cutoff of 5 or higher, categories of depression were defined as none (scores: 0-4); anxiety was defined using the Generalized Anxiety Disorder-7 cutoff of 5 or higher, categories of anxiety were defined as none (scores: 0-4); sleep disturbance was defined as a total Pittsburgh Sleep Quality Index score of > 5, categories of sleep disturbance were defined as none (scores: 0-5). Sociodemographic, lifestyle behaviors, and clinical characteristics were collected. Pearson correlation analysis was used to examine correlations among D/A/S. Univariate and multivariate logistic regression analyses were applied to identify factors associated with these conditions.

A total of 1107 patients were analyzed. D/A/S were identified in 36.6%, 19.1%, and 46.3% of the patients with chronic pain, respectively. The co-occurrence of two or three symptoms was 12.8-26.6%. In the multivariate analysis, patients who reported poor self-rated health (odds ratio [OR] 1.89, 95% confidence interval [CI] 1.33-2.68) and neuroticism (OR 1.06, 95% CI 1.02-1.09) were associated with depression. Neck pain (OR 2.60, 95% CI 1.53-4.42), alcohol consumption (OR 1.83, 95% CI 1.12-2.99), neuroticism (OR 1.09, 95% CI 1.05-1.13), and pain interference (OR 1.33, 95% CI 1.17-1.50) were correlated with anxiety. Alcohol consumption (OR 1.64, 95% CI 1.16-2.32) and pain interference (OR 1.12, 95% CI 1.03-1.23) were associated with sleep disturbance.

Among patients with chronic pain, D/A/S are prevalent and linked to distinct factors. Alcohol consumption and pain interference may be associated with both anxiety and sleep disturbance, while neuroticism may be linked to both depression and anxiety. Future systematic management of multifactorial factors may improve their mental health.