“Depression and Chronic Pain”
Agrability National Conference
November 18, 2004
Crowne Plaza Hotel
Springfield, IL
David Weis, LCPC, Chestnut Health Systems Employee
Assistance And Workplace Services, ADM National Account Manager
Services, ADM National Account Manager
About Chestnut Health Systems
• Not-for-profit behavioral healthcare provider started in
1973
• Headquartered in Bloomington, IL about 650
employees
• JCAHO accredited since 1983
• One of the first addiction treatment centers in the
country to be accredited
About Chestnut Health Systems
• Diverse array of services:
-addiction treatment
-community mental health services
-prevention and school based programs
-applied research & evaluation
-domestic and international employee assistance
services
Facts about depression
• Affects about 10% of the U.S. population with nearly three out
of four in the workplace (Gemignani, 2001)
• Prevalence among school age children and adolescents is
4.6% (Wagner, 2003)
• Millions do not seek treatment due to inadequate benefits and
the stigma associated with depression (U.S. Surgeon General,
2000)
• Effective pharmacotherapy combined with psychotherapy has
been shown to reduce healthcare costs and the rate of suicide
attempts (Ballenger, 1999)
• Average disability length as well as disability relapse are
greater for depression than most comparison medical groups
(Conti and Burton, 1994)
Types of depression:
• Unipolar
• Bipolar
• Dysthymia
• Seasonal Affective Disorder (SAD)
Symptoms of depression: DSM- IV Criteria
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Occurring over a two week period
Helplessness/hopelessness
Anhedonia
Poor concentration
Sleep disturbance (initiating and/or maintaining sleep)
Suicidal ideations
Appetite disturbance (typically weight loss, but in a
small subgroup, weight gain).
Symptoms of depression
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Depressed mood
Tearfulness
Irritability
Low energy level
Guilt
Pain perception
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“Is it all in my head?”
Emotional aspects of pain
Biology of pain perception
Cultural factors
Models of pain
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Peripheral vs. Central
Disease vs. illness-behavior
Reductionistic vs. systems
Biomedical vs. Biopsychosocial
Medical vs. Self-Management
Assessment of chronic pain and depression
• Patient Health Questionnaire (PHQ)
• Zung Depression Inventory (ZDI)
• Beck Depression Inventory (BDI)
Assessment of chronic pain and depression
• Standardized Instruments
• Pain Patient Profile (P-3)
• P-3 is a test that helps screen for the presence of
depression, anxiety, and somatization—the factors
most frequently associated with chronic pain.
Assessment of chronic pain and depression
• Overview: administration to individuals 17-76, reading level is
8th grade and it takes 12-15 minutes to complete, 44 groups of
statements with 3 statement per group
• Has validity scale to assess for random response and/or
symptom magnification
• Report includes; results summary, clinical interpretation, pain
patient profile and treatment recommendations.
• Cost is approximately $11/report with appropriate testing
software
Assessment of chronic pain depression
Million Behavioral Health Inventory (MBHI)
• Overview; administration to individuals 18 year and older, reading
level is 8th grade, 150 questions and takes approximately 20
minutes to complete
• Report includes basic coping styles, psychosomatic correlates, and
psychogenic attitudes such as stress level, premorbid pessimism
and future despair. Also includes a section on prognostic indicators
such as pain treatment responsitivity and emotional vulnerability
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Cost is approximately $27/report with software
Assessment of chronic pain and depression
• Minnesota Multiphasic Personality Inventory
(MMPI-2)
• Consist of 567 true/false questions
• Internal reliability/validity scales
• Takes approximately 90 minutes to complete
• Most widely recognized instrument use in forensic
evaluations
• Report includes; diagnosis, critical items, addiction
potential and treatment receptivity
Assessment of chronic pain and depression
• Clinical interview (Biopsychosocial factors)
• Substance abuse evaluation (prescription and/or
illicit)
• Suicide assessment
• Case management
Psychological management of chronic pain:
• Locus of control (internal vs. external)
• Stress Management
• Assertiveness Training
• Exercise
Psychological management of chronic pain:
• The role of attention focus and complaint
• Treatment personnel
• The faith factor
• Accessing support systems
• Lifestyle changes
Psychological management of chronic pain:
• Medication use (indications/contraindications)
• Cognitive-behavioral approaches
• Family systems approaches
• Case Management
Barriers to treatment:
• Inadequate assessment/missed diagnoses
• Co-morbid conditions (such as diabetes, stroke,
cancer etc)
• Substance abuse
• Lack of available resources
• Poor continuity of care
• Inappropriate medication dosing/titrating
• Lack of behavioral health treatment providers in rural
areas
Intervention considerations for Agrability
• Selection of an appropriate screening tool to be
utilized by Agrability field workers
• Development of a database of resource and referral
options
• Development and implementation of a training
program for workers involved in assessment of
farmers with disabilities. A resource manual would be
included
• Administration of a technical support line where
Agrability workers could receive expert consultation on
screening and referral issues