Level of Depression, Anxiety, and Stress among patients with chronic Musculoskeletal Pain in Bhutan: a cross-sectional study

Abstract

Background: Chronic musculoskeletal pain has brought about a significant worldwide burden in terms of health issues such as limited functionality, mobility, quality of life, and activities of daily living. In Bhutan, persistent musculoskeletal pain is increasing and reported yearly in a huge number of cases. Still, the relationship between CMP and psychological outcomes like depression, anxiety, and stress is underexplored in Bhutan. This research study focuses on finding the initial associations between CMP, sociodemographic characteristics, and psychological elements. Method: This study employs a cross-sectional design. The study involves 213 participants, and three hospitals were selected for this study. The sampling method employed was a convenience sampling technique. The chronic pain intensity of CMP was measured by the Chronic Pain Graded Scale (CPGS), and psychological outcomes were assessed by the Depression, Anxiety, and Stress Scale (DASS-21). Descriptive statistics were reported using median and interquartile range. Inferential statistics were reported by non-parametric tests like Mann-Whitney U-tests, Kruskal-Wallis test, Spearman correlation, and quantile regression test. Result: The median age of the participants was 41 (IQR = 23). Among 213 participants with CMP, 47.5% reported depression, 40.8% reported anxiety, and 27% reported stress. Depression levels were significantly higher among females (U = 4613.5, p = .018) and unemployed participants (U = 4374.5, p = .029). No significant gender and employment differences were observed in anxiety (p = .085 and .933) and stress (p = .145 and .932). A moderate positive relationship was identified using Spearman’s correlation between pain-related disability and depression (ρ = .422, p = .000) and stress (ρ= .397, p = .000), while a weak but significant relationship was observed with anxiety (ρ = 0.211, p = 0.002). Pain severity also showed significant positive correlations with depression (ρ = .422, p = .000), weak correlation with anxiety (ρ = .176, p = .010), and stress (ρ = .280, p = .001). Age showed no significant correlation with depression (ρ = -.010, p = .886), but demonstrated a significant, weak negative correlation with anxiety (ρ = -.260, p = .000) and stress (ρ= -.189, p = .006). Significant predictors for Depression, anxiety, and stress include age, pain-related disability, and being female. Conclusion: Chronic musculoskeletal pains is significantly related to depression, anxiety, and stress among Bhutanese patients, particularly among women, unemployed individuals, and younger adults. Pain severity and pain-related disability were positively correlated with psychological outcomes. These outcomes emphasize the need for a holistic approach that includes mental health screening in physiotherapy services for CMP patients, particularly for women, young, and unemployed patients, promoting a culturally sensitive, biopsychosocial approach that aligns with the national commitment of holistic patient-centered care. Key words: chronic musculoskeletal pain, depression, anxiety, stress, psychological distress, Bhutan, biopsychosocial approach