Diagnosis of Depression and Chronic Back Pain: Depression Questionnaire

One of the biggest problems in treating major depression for the patient with chronic back pain is missing the diagnosis. This occurs for two reasons: the chronic back pain patients often do not realize they are also suffering from a major depression, and the doctor is not looking for depression.

Chronic back pain patients will often define their problem as strictly medical and related to the pain. This is supported by a recent study which found that individuals with chronic pain and depression went to their physicians 20% more often than a comparison group of non-depressed medical patients. In addition, depressed chronic back pain patients were 20% less likely to see a mental health specialist than medical patients without a pain problem (Bao, Sturm, & Croghan, 2003).¹

The depressive symptoms may be downplayed by the chronic back pain patient who believes that, “just get rid of this pain and I won’t feel depressed” or that acknowledging depression is a sign of weakness in dealing with the pain. When the diagnosis of major depression in the chronic back pain patient is missed or ignored, treatments strictly directed at the pain are much more likely to fail.

As concluded by Ohayon and Schatzberg (2003), the presence of a chronic pain physical condition increases the duration of depressive mood, and chronic pain patients seeking medical consultation should be routinely screened for a major depression.²

Simultaneous Treatment for Depression and Chronic Back Pain

Treatment of depression associated with chronic back pain requires a specialized approach. It is generally accepted that the pain and the depression should be treated simultaneously in a multidisciplinary fashion. The treatment of clinical depression most often includes psychological interventions (e.g. counseling, relaxation training, etc) and anti-depressant medication.

In a recent review of the research from 1980 though 2000 that looks at treatment of depression, it was found that the combined treatment approach of medication and psychotherapy yielded better outcomes than either of the interventions alone (Pampallona et al., 2004).³ Simultaneous treatment directed at the chronic back pain is critical. It has been found that chronic pain may interfere with depression improvement.

Treatment for the chronic pain might include such things as physical rehabilitation aimed at restoration of function, trying to “normalize” one’s life as much as possible even with the pain, appropriate medication management, among other things. Multidisciplinary treatment of the chronic back pain and major depression will ultimately give the patient more of a sense of control over the pain and start a “positive spiral” toward physical and mental re-conditioning.

Assessing Depression

The Depression Questionnaire is a self-administered test that patients can take to gauge the severity of their depression. If the score is in the moderate to severe range, the patient should discuss the results with his or her doctor or back specialist. It may find be helpful to print up this page to take the depression questionnaire and record the answers and final score.

The Depression Questionnaire

It may be helpful for patients to print this page to more easily record their answers and score.

Using the following scale for each of the listed symptoms, the patient should circle the number that best indicates how much of this type of feeling has been experienced over the past one to two weeks. Make sure that all the questions are answered. If it is difficult to answer any of the questions, a best guess should suffice.

The scale is as follows:

0 = Not at all
1 = Somewhat
2 = Moderately
3 = A lot

Symptoms	Somewhat	Moderate	A lot
Do you feel sad, low, blue, or unhappy?	1	2	3
Do you feel hopeless or discouraged about the future?	1	2	3
Do you feel useless or believe yourself to be a failure?	1	2	3
Do you feel inadequate or inferior to others?	1	2	3
Do you feel guilty or blame yourself for everything?	1	2	3
Do you find it difficult to make decisions?	1	2	3
Do you feel frustrated and irritable?	1	2	3
Have you lost interest in other people or your usual activities?	1	2	3
Do you feel unmotivated and find it difficult to do things?	1	2	3
Do you think you’re looking old, unattractive or ugly?	1	2	3
Have you lost your appetite or had a change in weight not due to dieting?	1	2	3
Do you have trouble falling asleep, or do you wake up during the night, earlier than you would like?	1	2	3
Do you feel tired much of the time?	1	2	3
Have you had crying spells or felt like crying but couldn’t?	1	2	3
Have you lost your interest in sex?	1	2	3
Do you worry often about your general health even beyond the upcoming surgery?	1	2	3
Do you have thoughts about killing yourself or do you think you might be better off dead?*	1	2	3

Add up your total score for the 17 symptoms and record it for scoring.

The total score will be somewhere between 0 (answering “Not at all” to each item) and 51 (answering “A lot” for each item). Use the following key to interpret your score:

Total Score	Degree of Depression
0-4	Minimal or no depression
6-11	Borderline depression
12-21	Mild depression
22-31	Moderate depression
32-51	Severe depression

*If you have had thoughts about killing yourself or scored in the severe range of depression, you should consult a qualified mental health professional.

References

1.Bao Y, Sturm R, Croghan TW. A national study of the effect of chronic pain on the use of health care by depressed persons. Psychiatric Services. 2003;54:693-697.
2.Ohayan MM, and Schatzber AF. Using chronic pain to predict depressive morbidity in the general population. Archives of General Psychiatry. 2003;60:39-47.
3.Pampallona S, Bollini P, et al. Combined pharmacotherapy and psychological treatment for depression: A systematic review. Archives of General Psychiatry. 2004;61:714-719.

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