Contributing factors of depression for individuals with chronic musculoskeletal pain in workers' compensation settings - A ecological conceptualization in rehabilitation counseling intervention

Depressive disorders are the most common form of mental illnesses that individuals seek professional help (Agency for Health Care Policy Research [AHCPR], 1999) in the general population. The AHCPR report estimated that one in five individuals (20%) is affected by a mood disorder in his/her lifetime. Approximately 10% of the population will develop an episode of depression within a one-year period and the lifetime prevalence of depression can be as high as between 25-50% (Lewinsohn, Hoberman, & Hautzinger, 1985). For people with disabilities and illnesses, research indicated that the incidence of depression is reported to be higher in this population as compared to the general population. Turner and McLean's study (1988) indicated that people with physical disabilities are three to four times more likely than people without disabilities to have had an episode of major depression within six months. Among people with physical disabilities, people experiencing chronic pain often has a high co-morbidity of depression (Banks & Kerns, 1996; Brown, 1990; Fordyce, 1982; Monsein & Cliff, 1995; N.A., 2004; Ohayon, 2004) than those without chronic pain. Ohayon (2004) conducted an epidemiological study on more than 18,000 individuals in the general population and their results indicated that 43.4% of individuals with major depressive disorders also reported having a chronic painful physical condition, in which this population experienced a longer duration of depressive symptoms, higher fatigue, higher insomnia, more severe psychomotor retardation and more severe concentration problems. Another study (authors not identified) conducted in 2004 on the comorbidity of chronic pain and depression reviewed that the prevalence of major depressive disorders in a primary care setting has been reported to range between 7% and 12% while the prevalence of chronic pain reported in much higher, ranging from 38% to 46%. Banks and Kerns (1996) reviewed that the prevalence rate of depression among clients experiencing a general musculoskeletal chronic pain ranged from 30% to 54%. Polatin and colleagues (1993), in a large-scale study of men and women who experience low back pain, reported that 64% of the participants fulfill criteria for major depression. On the basis of formal diagnostic criteria, 57% of the participants have one or multiple diagnosis of Axis I clinical disorders prior to their injury. Rehabilitation professionals, such as rehabilitation counselors, work closely with people with variety of disabilities and chronic illnesses, ranging from individuals with progressive illnesses such as fibromaygia, cancer, and terminal illnesses in hospitals to individuals who experience adult-onset trauma and injuries, such as work-related injuries. Pain can be one of the manifestations resulting from those disorders and illnesses which often hinder the rehabilitation process. Rehabilitation is unique in several perspectives in terms of its' philosophy of treatment and intervention. One of the major focuses of traditional rehabilitation counseling is to assist individuals to enroll in gainful employment in both the federal/state vocational rehabilitation as well as in private sector rehabilitation (workers' compensation) (Parker & Szymanski, 1998; Rubin & Roessler, 1995). Although there is a continuous expansion of rehabilitation goals from employment success to other imperative functions of life such as quality of life and independence living, work remains to be one of the therapeutic and essential interventions for both the physiological survival and psychological well-being of people in contemporary societies (Dawes, Lofquist, & Weiss, 1968; Perrone, Perrone, Chan, & Thomas, 2000). While work implementation can be therapeutic to individuals with the illness or injury, rehabilitation counselors are cognizant of the complexity of the causes as well as the impact of the disability on the individuals and their functions, and rehabilitation counseling practice often takes a more ecological and holistic perspective in case conceptualization and intervention. …