Dear Colleagues,

Pain and depression are non-communicable conditions affecting individuals across the globe. Of significant public health importance, according to the Global Burden of Disease (GBD) studies, low back pain, headache disorders, and depressive disorders are ranked as the 1st, 2nd, and 3rd causes of Years Lived with Disability (YLD) in 2017 for females and the 1st, 2nd, and 5th causes of YLD for males. Indicative of the over-time importance of low back pain and headache disorders for disability burden world-wide, GBD rankings for these conditions were identical in the 1990 and 2007 YLD report. The rankings for depressive disorders for these earlier years were almost as consistent.

Self-rated health (SRH), is commonly defined as an individual’s response to a single item or question such as “In general, would you say that your health is: excellent, very good, good, fair, or poor.” Evidence from many studies, across age, gender, and cultural groups, shows that individual SRH is a strong, independent predictor of subsequent mortality and morbidity in which risk increases with each rating less than ‘excellent’. As such, self-rated health has potential prognostic importance for both public health and clinical practice. Some public health practitioners use aggregated self-health ratings to indicate the general health status of a population. Although not yet fully characterized, those who study self-rated health recognize it as an individual-level variable that reflects self-perceptions and evaluations in addition to physical and mental health status.

While pain and depression and self-rated health are recognized as distinct, chronic pain, unipolar depression, and fair or poor self-rated health are frequently comorbid within an individual. Data from a large nationally representative sample (n=42,716) of the US adult community dwelling adult (≥18 years old) population in which activity living pain, depressive disorders, and self-rated health were cross-sectionally assessed show the following: 6.6% report co-morbid moderate to severe pain interference, minor or major depressive disorder, and fair or poor self-rated health; 11.1% report 2 of these conditions to be co-morbid, and 28.1% one of these conditions. No elevated levels of pain, depression, or SRh were reported by 53.9 of the sample.

Despite their frequent and comorbid occurrence and resulting relevance for individual and global public health, pain, depression, and self-rated health typically have been underappreciated by public health practitioners and educators. Moreover, although the prognostic significance of self-rated health has been well established, clinicians seldom use this information in their clinical practice.

This Special Issue calls for papers that specifically address the incidence, risk factors for, and/or consequences of the paired or totally co-morbid occurrences of pain, depression, and low self-rated health. Papers that integrate perspectives from such disciplines as epidemiology, psychology, sociology, clinical, and public health practice are strongly appreciated. We are hopeful that the Special Issue will a) provide readers from diverse public health and clinical backgrounds an informed understanding of the significance of pain, depression, and self-rated health, alone or in combination; b) stimulate greater inclusion of these human experiences in public health curricula and those of other clinical fields; and c) encourage the development and implementation of pertinent findings in public health and clinic practice.

Due to the focus on co-morbidities, we understand submitted papers are most likely to be based on data from existing, rigorous cross-sectional, or longitudinal studies of samples representative of defined populations in which at least 2 of our targeted variables were assessed. Studies limited to representative clinical populations are also welcome. Recommended research topics/questions could include, but are not limited to, the following:

• What is the distribution of classes of co-morbid pain, depression, and low self-rated health in the general population (or well defined non-clinical/clinic populations)? On what characteristics do those with the target co-morbidities differ from their unaffected age-mates?
• Are the characteristics of those who experience co-morbid combinations of pain, depression, and low self-rated health the same across the globe or do they differ according to such factors as country income level, cultural background, or health resource availability?
• What are the risk factors for experience of pain, depression, or low self-rated health? Are the risk factors similar for each outcome?
• Do the risk factors for experiencing co-morbid pain, depression, and low self-rated health reflect those for each outcome when occurring separately?
• To what extent are pain, depression, and low self-rated health chronically co-morbid. If not, how do changes in one condition impact levels of the others?

Prof. Dr. Jana Mossey
Guest Editor

Manuscript Submission Information

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• Pain
• Self-rated health
• Depression
• Co-morbidity
• Epidemiology
• Health outcomes
• Global disease burdens