By Lauren DeSouza- Master of Public Health, Simon Fraser Public Research University – Canada

https://nhcrisishouse.com/our-team/

Staff Research and Content Writer

© Copyright – SUD RECOVERY CENTERS – A Division of Genesis Behavioral Services, Inc., Milwaukee, Wisconsin – July 2024 – All rights reserved.

In recent decades, we have made remarkable strides in understanding mental health and addressing mental illness. Stigma around discussing mental health is greatly reduced and treatments are more abundant and readily available.

However, this progress has not been experienced equitably across the population. Many populations continue to experience higher-than-average rates of mental illness, especially those with co-occurring health or social disparities. Unfortunately, the mental health treatment needs of these communities tend to go unmet.

The needs of those with chronic pain, who make up approximately 20% of the U.S. adult population, have been left off of the national mental health care agenda. Adults with chronic pain are 5 times more likely to have untreated mental health symptoms compared to the general population. Those with chronic pain comprise the majority of U.S. adults living with unremitted (ongoing and untreated) anxiety or depression. Though medical researchers are aware of this disproportionate burden, few studies have been done investigating mental health treatment-

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seeking behavior and usage among adults with chronic pain and anxiety or depression.

A new study aims to elucidate the gaps in mental health treatment for those living with chronic pain and experiencing symptoms of anxiety or depression. The study’s researchers were interested in understanding whether there were differences in mental health treatment needs and utilization between those who do and do not have chronic pain and why those differences may persist.

What did this study do?

In this cross-sectional study, researchers used data from the National Health Interview Survey to understand the burden of mental health concerns among adults with chronic pain. The National Health Interview Survey is considered the best survey for monitoring the epidemiology of chronic pain in the United States. As it incorporates validated screening tools for anxiety and depression, the survey can provide insight into the rates of mental health concerns among adults with chronic pain and enable comparison to the general population.

The researchers employed the following definitions in their analyses:

  • Chronic pain: Categorized as responding “most days” or “every day” to the question, “In the past 3 months, how often did you have pain?”
  • Mental health treatment: Categorized as taking medication for anxiety or depression and/or attending counseling or therapy in the past 12 months.
  • Mental health treatment need: Included those who reported having symptoms of anxiety or depression, those who were using treatment, or both. This enabled the researchers to include those for whom treatment had worked to mitigate their symptoms (and who therefore responded “no” to having symptoms) in the overall burden of treatment need.

The researchers then conducted a cascade-of-care analysis to identify vulnerabilities and gaps between healthcare systems and population needs. They used this approach to determine how well the mental health treatment need was being met for U.S. adults with co-occurring chronic pain. This allowed them to compare the met or unmet treatment needs of adults with and without chronic pain and identify gaps faced by those living with chronic pain.

What did the study find?

In the first part of their analysis, the researchers confirmed that U.S. adults with chronic illness carry a disproportionate burden of mental health concerns compared to the general population.  Adults with chronic pain were more likely to experience symptoms of depression or anxiety, and for most people, these symptoms were clinically significant. The study showed that while people living with chronic pain represent 20.4% of the U.S. adult population, they make up an estimated 55.5% of U.S. adults with clinically significant anxiety and depression symptoms. Mental health treatment need was also substantially more prevalent among U.S. adults living with chronic pain than among those without chronic pain  (43.2% vs 17.4%).

Those living with chronic pain were also less likely to be receiving treatment for their mental health symptoms compared to the general population. Of those needing mental health treatment, 71.5% of adults without chronic pain used mental health services compared to only 44% of those with chronic pain. This demonstrates that adults with chronic pain access mental health care at lower rates than others with mental health needs, implying a meaningful treatment gap for those with chronic pain.

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This finding held even when accounting for factors such as health insurance status, age, sex, race/ethnicity, presence/absence of a cancer diagnosis, and presence of functional limitations in daily life. This suggests that there are chronic pain-specific barriers to mental health treatment for adults living with chronic pain in the U.S.

The cascade-of-care analysis suggested that chronic-pain-associated gaps may exist in the following areas along the continuum of care:

  • Disproportionately frequent need for mental health treatment among those with chronic pain.
  • Disproportionately infrequent use of mental health treatment among those with chronic pain.
  • Persistent symptoms of anxiety or depression even for those who used mental health treatment.

The authors outlined 7 possible chronic pain-specific barriers to mental health treatment:

  1. A belief that chronic pain needs to be addressed before treating mental health symptoms or that addressing chronic pain will provide relief from mental health symptoms.
  2. Providers often overlook the mental health needs of chronic pain patients, opting for a singular approach to treatment instead of integrating mental health care.
  3. An internalized mental health treatment stigma among patients with chronic pain that prevents treatment seeking.
  4. Low accessibility and feasibility of mental health treatment (e.g., time or mobility concerns) for people with chronic pain.
  5. A lack of training for mental health providers in addressing co-occurring chronic pain.
  6. A lack of provider awareness of mental health treatment protocols for those with chronic pain.
  7. Issues in assessing/diagnosing mental illness among those with chronic pain due to overlapping symptoms.

What are the implications of these findings?

The U.S. mental health treatment system chronically underserves people with chronic pain who experience mental health symptoms. This population not only faces a disproportionately high burden of mental health symptoms but accesses treatment at a lower rate. Moreover, treatment appears to be less effective for adults with chronic pain compared to the general population. Treatment gaps appear across the continuum of care for people with chronic pain, owing to misconceptions from providers and patients themselves, lack of training, and challenges in assessing and treating mental illness in those with chronic pain.

Further research is necessary to uncover the driving forces behind these disparities and to create interventions that can address the suboptimal mental health treatment experiences of U.S. adults with chronic pain.

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What are the key takeaways?

  • Adults with chronic pain have a disproportionately high burden of mental health symptoms compared to the general population.
  • Mental health treatment uptake is lower among adults with chronic pain.
  • Mental health treatment is less effective among adults with chronic pain, who tend to continue exhibiting mental health symptoms even after treatment.
  • Treatment gaps appear across the continuum of care for adults with chronic pain, contributing to their unmet mental health treatment needs.
  • Further research is critical to understand and address the gaps in mental health treatment needs in adults with chronic pain.

Reference

De La Rosa, Jennifer S.a,b,*; Brady, Benjamin R.a,c; Herder, Katherine E.a,d; Wallace, Jessica S.a,b; Ibrahim, Mohab M.a,e; Allen, Alicia M.a,b; Meyerson, Beth E.a,b; Suhr, Kyle A.a,f; Vanderah, Todd W.a,g. The unmet mental health needs of U.S. adults living with chronic pain. PAIN ():10.1097/j.pain.0000000000003340, July 30, 2024.