Recall bias affects pain and depression assessment in multimorbidity: a pilot study

Older adults with multimorbidity (OAMM) commonly receive depression and pain management through primary care, where symptoms are typically assessed through retrospective recall. Even with validated questionnaires, recall bias has been reported in younger populations for both depression and pain. However, recall bias for depression and pain has not been explored in OAMM. We examined discrepancies between prospectively measured and recalled symptoms of depression and pain among OAMM.

We analysed data generated from a 14-day pilot feasibility trial of ecological momentary assessment (EMA) in OAMM (N = 18, age range 67-95). We examined discrepancies between retrospectively assessed depression and pain intensity over two weeks compared to follow-up, baseline characteristics correlated with discrepancies, and recency effects.

We found overreporting across most symptoms, with the largest discrepancies between prospectively recorded and recalled symptom scores for pain intensity and fatigue (d = .49). There was no association between recalled and EMA-measured items for appetite and trouble sleeping. Pain intensity at day 14 was associated with discrepancies in recalled pain (r = -.52, p =.029), and both day 14 mood and negative self-thoughts were associated with discrepancies in trouble concentrating recall (r = -.67, p =.002 and p = -.72, p <.001, respectively) - suggesting recency effects.

We found preliminary evidence of recall bias among OAMM, including overreporting and recency effects of pain and depression symptoms. Given the reliance on recall during primary care visits, more research is needed.