Academic Journal
Do somatic symptoms bias depression screening? Reliability and equivalence of PHQ-8 in those with and without chronic pain: A nationally representative study of U.S. adults.
| Title: | Do somatic symptoms bias depression screening? Reliability and equivalence of PHQ-8 in those with and without chronic pain: A nationally representative study of U.S. adults. |
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| Authors: | De La Rosa JS; Comprehensive Center for Pain & Addiction, University of Arizona, USA; Department of Family and Community Medicine, University of Arizona College of Medicine - Tucson, USA; Department of Pharmacology, University of Arizona College of Medicine - Tucson, USA. Electronic address: jschult1@arizona.edu., Chism GT; Comprehensive Center for Pain & Addiction, University of Arizona, USA; College of Information Science, University of Arizona, Tucson, USA., Herder KE; Comprehensive Center for Pain & Addiction, University of Arizona, USA; Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, USA., Mun CJ; Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, USA; Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA., Aaron RV; Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD, USA. |
| Source: | Journal of affective disorders [J Affect Disord] 2026 Jul 15; Vol. 405, pp. 121496. Date of Electronic Publication: 2026 Feb 23. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Elsevier/North-Holland Biomedical Press Country of Publication: Netherlands NLM ID: 7906073 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-2517 (Electronic) Linking ISSN: 01650327 NLM ISO Abbreviation: J Affect Disord Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Amsterdam, Elsevier/North-Holland Biomedical Press. |
| MeSH Terms: | Chronic Pain*/psychology , Chronic Pain*/epidemiology , Depression*/diagnosis , Depression*/epidemiology , Patient Health Questionnaire*/standards , Medically Unexplained Symptoms*, United States/epidemiology ; Humans ; Female ; Reproducibility of Results ; Adult ; Male ; Middle Aged ; Aged ; Mass Screening ; Health Surveys ; Young Adult ; Prevalence ; Adolescent |
| Abstract: | The 8-item Patient Health Questionnaire (PHQ-8) is implemented into clinical practice and scientific research worldwide. However, in the context of chronic pain (CP), depression screening could be confounded by overlapping somatic symptoms. Inaccurate attribution of CP symptoms to depression could lead to overestimation of depressive symptom severity or even artifactual inflation of depression prevalence estimates. We aimed to determine the reliability and equivalence of PHQ-8 in adults with and without CP. This nationally representative survey study examined data from the 2019 National Health Interview Survey. The final analytic sample contained (n = 30,983) U.S. adults who completed survey items on CP and the PHQ-8. Descriptives and visualizations were generated; reliability, cross-group equivalence, and measurement invariance were assessed. The PHQ-8 was reliable; measurement invariance and cross-group equivalence were observed at the configural, metric, and scalar levels; differential item functioning was not observed. No evidence consistent with overestimation of depression prevalence or severity in the contexts of CP or HICP was observed. The PHQ-8 is reliable and measures depressive symptoms equivalently in the context of CP, supporting the use of PHQ-8 to screen for depression in clinical practice, scientific research, and population health surveillance of adults with and without CP. CP is regularly observed to be associated with five to ten times greater prevalence of positive screens for clinically significant depressive symptoms. This study offers compelling evidence that this disparity reflects true differences in the prevalence of depression in those with chronic pain and is not attributable to measurement artifacts. (Copyright © 2026 The Authors. Published by Elsevier B.V. All rights reserved.) |
| Competing Interests: | Declaration of competing interest The authors have no conflicts of interests to declare. |
| Grant Information: | K12 TR005467 United States TR NCATS NIH HHS; K23 HD104934 United States HD NICHD NIH HHS; P30 CA023074 United States CA NCI NIH HHS |
| Contributed Indexing: | Keywords: Chronic pain; Depression; Depressive symptoms; PHQ-8; Screening; Somatic symptoms |
| Entry Date(s): | Date Created: 20260225 Date Completed: 20260709 Latest Revision: 20260802 |
| Update Code: | 20260802 |
| PubMed Central ID: | PMC13034849 |
| DOI: | 10.1016/j.jad.2026.121496 |
| PMID: | 41740761 |
| Database: | MEDLINE |
| ISSN: | 1573-2517 |
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| DOI: | 10.1016/j.jad.2026.121496 |