Cross-Sectional Associations Among Symptoms of Pain, Irritability, and Depression and How These Symptoms Relate to Social Functioning and Quality of Life: Findings From the EMBARC and STRIDE Studies and the VitalSign6 Project

Manish K. Jha, MBBS; Alan Schatzberg, MD; Abu Minhajuddin, PhD; Cherise Chin Fatt, PhD; Taryn L. Mayes, MS; Madhukar H. Trivedi, MD

J Clin Psychiatry 2021;82(3):20m13740

ABSTRACT

Objective: The aim of this report was to evaluate the psychometric properties of the Pain Frequency, Intensity, and Burden Scale (P-FIBS), a brief measure of pain, as well as the association of pain with irritability and depression and how these symptoms relate to functional impairments.

Methods: Participants of 2 randomized controlled trials (Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care [EMBARC; n = 251 with DSM-IV diagnosis of major depressive disorder; study duration: August 2011–December 2015] and STimulant Reduction Intervention Using Dosed Exercise [STRIDE; n = 302 with DSM-IV diagnosis of stimulant abuse or dependence; study-duration: July 2010–February 2013]) and treatment-seeking patients in primary care clinics from an ongoing quality-improvement project (VitalSign⁶; n = 4,370; project duration: August 2014–July 2019) were included. Psychometric properties of the P-FIBS were evaluated with confirmatory factor and item response theory analyses in EMBARC and VitalSign⁶. The approach of Baron and Kenny was used to assess whether irritability accounted for the effect of pain on depression.

Results: Cronbach α (0.84–0.89) and model fits for single-factor structure of P-FIBS were acceptable. Pain was positively correlated with irritability (r = 0.22–0.29) and depression (r = 0.10–0.33). Irritability accounted for 40.7%–65.5% of the effect of pain on depression. Higher irritability and depression were associated with poorer social functioning, quality of life, and productivity in work- and non–work-related activities. Pain was associated with non–work-related activity impairments even after controlling for irritability and depression.

Conclusions: The P-FIBS is a brief and reliable measure of pain. Irritability is associated with pain and accounts for a large proportion of the effect of pain on depression. Symptoms of pain, irritability, and depression are associated with functional impairments.

Trial registration: ClinicalTrials.gov identifiers: NCT01407094 (EMBARC), NCT01141608 (STRIDE).

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