Pain intensity and comorbid depressive symptoms in the general population: An analysis of the German Health Update Study (GEDA 2019/2020-EHIS).

Background: Pain and depressive symptoms often co-occur, but the influence of pain intensity remains unclear. This study analyses the association between pain intensity and depressive symptoms in the general adult German population.

Methods: Data was obtained from the cross-sectional German Health Update Study (GEDA 2019/2020-EHIS). Pain intensity in the last 4 weeks was categorized into no pain, mild, moderate, and severe. Depressive symptoms were assessed using the 8-item Patient Health Questionnaire (PHQ-8). The prevalence of depressive symptoms was analysed including a 95% confidence interval (95% CI). A multivariable logistic regression analysed associated factors with depressive symptoms by odds ratio (OR).

Results: Of 22,708 participants (51.0% women, 35.1% aged 45-64 years), 41.2% reported no pain, 32.1% mild, 15.3% moderate, and 11.5% severe pain. Depressive symptoms were present in 8.3% overall (women 9.1%, men 7.5%). Participants with no pain, mild, moderate, and severe pain reported depressive symptoms in 2.5%, 6.5%, 14.4%, and 27.1%, respectively. In the multivariable analysis, higher pain intensity was associated with a higher risk of depressive symptoms (mild pain OR 1.8, 95% CI 1.3-2.4; moderate pain OR 2.8, 95% CI 2.0-4.0; severe pain OR 4.0, 95% CI 2.8-5.6). Depressive symptoms were further associated with a Body Mass Index (BMI) under 18.5 kg m (OR 2.4; 95% CI 1.4-4.1), but not with sex (OR 1.1; 95% CI 0.9-1.3).

Conclusions: Higher pain intensity increases the risk of depressive symptoms. We suggest regular assessment of pain and further assessment of depressive symptoms in patients with moderate or severe pain.

Significance Statement: Our study found a clear association between higher pain intensity and depressive symptoms in the general population across all types of pain. Further, being underweight was linked to depressive symptoms overall and the highest prevalence of depressive symptoms was found in underweight persons with severe pain. These findings highlight the importance of assessing depressive symptoms in patients with higher pain intensity, especially in underweight patients.