Identification of Undiagnosed Depression in Patients with Chronic Musculoskeletal Low Back Pain in a Nurse Practitioner Urban Primary Care Practice

This study examined: (a) the incidence of concomitant depression in the chronic pain population at a clinic serving the underserved in a metropolitan area, (b) the reported incidence of depression in men vs. women, (c) the reported uses of substances in the depressed population, and (d) the perception of adequately treated pain in the depressed population and how it related to comorbid occurrence of depression. Dorothea Orem’s Self Care Theory, which states that every individual has the ability to perform self-care for optimum health, was the theoretical framework used for this study. Utilizing a convenience sample of subjects, men and women between the ages of 18-64 who were previously diagnosed with low back musculoskeletal pain and met inclusion criteria were recruited from a clinic providing primary care for the underserved population in a metropolitan area. Potential participants were approached and asked to complete an initial screening tool to determine suitability for participation in the study. Participants (N=42) completed a demographic and data questionnaire and a Beck Depression Inventory- Fast Screen (BDI). Of those who were previously diagnosed with depression, 1/4 of them received a referral for treatment, but 72% of those with depression were currently not being treated. In this study, findings revealed that more men (40.7%) than women (33.3%) were diagnosed as depressed. Scores were higher in men than women on the BDI-Fast Screen: 38.7% of men had moderate to severe depression compared to 13.3% of women. Women had more minimal-mild depression (46.7%) than men (26.9%). Of those diagnosed with depression, only 42.1% said their pain was adequately treated. Those who were not previously diagnosed with depression, 57.9% reported that their pain was not adequately treated. This study supported the use of routine assessment of levels of depression and initiating treatment when needed among the patients treated for chronic pain. Implications for nursing practice included recommendation for Identification the use of an assessment tool to screen and diagnose for depression, such as the BDI-Fast Screen, which identifies the severity of depression.Master of Science (MS)NursingUniversity of Michigan-Flinthttps://deepblue.lib.umich.edu/bitstream/2027.42/143276/1/VesnaughEtal.pd