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Open Access Highly Accessed Research article

Pain, not chronic disease, is associated with the recurrence of depressive and anxiety disorders

Marloes MJG Gerrits12*, Patricia van Oppen12, Stephanie S Leone2, Harm WJ van Marwijk2, Henriëtte E van der Horst2 and Brenda W Penninx134

Author Affiliations

1 Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, GGZ inGeest, Amsterdam, The Netherlands

2 Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands

3 Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands

4 Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands

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BMC Psychiatry 2014, 14:187  doi:10.1186/1471-244X-14-187

Published: 25 June 2014



Studies suggest that poor physical health might be associated with increased depression and anxiety recurrence. The objectives of this study were to determine whether specific chronic diseases and pain characteristics are associated with depression and anxiety recurrence and to examine whether such associations are mediated by subthreshold depressive or anxiety symptoms.


1122 individuals with remitted depressive or anxiety disorder (Netherlands Study of Depression and Anxiety) were followed up for a period of four years. The impact of specific chronic diseases and pain characteristics on recurrence was assessed using Cox regression and mediation analyses.


Chronic diseases were not associated with recurrence. Neck (HR 1.45, p < .01), chest (HR 1.65, p < .01), abdominal (HR 1.52, p < .01) pain, an increase in the number of pain locations (HR 1.10, p < .01) and pain severity (HR 1.18, p = .01) were associated with an increased risk of depression recurrence but not anxiety. Subthreshold depressive symptoms mediated the associations between pain and depression recurrence.


Pain, not chronic disease, increases the likelihood of depression recurrence, largely through its association with aggravated subthreshold depressive symptoms. These findings support the idea of the existence of a mutually reinforcing mechanism between pain and depression and are indicative of the importance of shedding light on neurobiological links in order to optimize pain and depression management.

Depressive disorder; Anxiety disorder; Recurrence; Pain; Chronic diseases