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Correlation between Depression and Anxiety in Patients with Chronic Non- Malignant Pain


1,4Irena Kovačević

2 Valentina Krikšić

1 Štefanija Ozimec Vulinec

3 Adriano Friganović

1 Boris Ilić

1 Sanja Ledinski Fičko

¹ University of Applied Health Sciences, Zagreb,


² Institution for Home Health Care „Domnius“, Zagreb, Croatia

3 University Hospital Centre Zagreb, Zagreb, Croatia

4 University of ljubljana, Faculty of Medicine, ljubljana, Slovenia


Article received: 18.03.2021.


Article accepted: 12.04.2021.


Author for correspondence:

Irena Kovačević

University of Applied Health Sciences Mlinarska 38, Zagreb, croatia




keywords: depression, anxiety, chronic non-malignant pain, ethnicity, primary health care





Introduction. Two-thirds of primary care patients with depression also have somatic symptoms pres- ent, making detection of depression more difficult. primary health care is the first level of screening for depression, and early detection is key to treat- ment success. Anxiety also has a high comorbidity rate with chronic pain conditions. generalized anxi- ety disorder (gAd) is common among patients with “medically unexplained” chronic pain and chronic physical illness and is also a predictor of chronic mus- culoskeletal pain after trauma. belonging to different ethnic groups and ignorance of these differences by primary care physicians can be an obstacle to good health care, especially early recognition of depres- sive symptoms.

Aim. The aim of this proposed, systematic work was to draw conclusions from empirical research deal- ing with the processes involved in the examination of depression, anxiety, and chronic non-malignant pain. The research question for this review paper was to examine the correlation of depression and anxiety with chronic non-malignant pain. The aim was to examine the role of primary health care in recognizing, preventing, and treating depression and anxiety in patients with chronic non-malignant pain, and whether there is a difference in the correlation between depression, anxiety, and chronic non-malig- nant pain according to ethnicity.

Methods. Methods for identifying the study were derived from the Medline database (via pubMed).

The analysis included all scientific papers in english, regardless of methodology, published since 2011. The papers dealt with the correlation between de- pression, anxiety, and chronic non-malignant pain, and included the population of primary care patients over 18 years of age who suffer from chronic non- malignant pain and at the same time have symptoms of depression and anxiety present or are members of ethnic groups. 403 articles were found, original and review papers, of which, after a detailed reading, 10 were selected that meet the inclusion criteria for the purposes of this review.

Results. Depression and anxiety are significantly more present in people with chronic pain (23%), compared to those who do not have chronic pain (12%). The most common is chronic musculoskeletal pain, with one-third of patients having depression. depression and anxiety are significantly associated with the intensity and duration of pain. chronic pain and depression also differ according to ethnic groups, with cultural differences and language barriers being a barrier to early detection of depression.

Conclusion. depression is the most common men- tal health disorder associated with chronic pain. it is extremely important to treat both depression and pain, in order to prevent the development of severe depression and chronic pain at an early stage. The integrated program at the level of primary health care is expected to have positive effects on both the physical and mental condition of patients. cultural differences and ethnicity, which can significantly re- duce the detection of depressive symptoms at the primary health care level, should certainly be taken into account.


keywords: depression, anxiety, chronic non-malignant pa- in, ethnicity, primary health care