Statistical modeling of acute and chronic pain patient-reported outcomes obtained from ecological momentary assessment.

ABSTRACT: Ecological momentary assessment (EMA) allows for the collection of participant-reported outcomes (PROs), including pain, in the normal environment at high resolution and with reduced recall bias. Ecological momentary assessment is an important component in studies of pain, providing detailed information about the frequency, intensity, and degree of interference of individuals' pain. However, there is no universally agreed on standard for summarizing pain measures from repeated PRO assessment using EMA into a single, clinically meaningful measure of pain. Here, we quantify the accuracy of summaries (eg, mean and median) of pain outcomes obtained from EMA and the effect of thresholding these summaries to obtain binary clinical end points of chronic pain status (yes/no). Data applications and simulations indicate that binarizing empirical estimators (eg, sample mean, random intercept linear mixed model) can perform well. However, linear mixed-effect modeling estimators that account for the nonlinear relationship between average and variability of pain scores perform better for quantifying the true average pain and reduce estimation error by up to 50%, with larger improvements for individuals with more variable pain scores. We also show that binarizing pain scores (eg, <3 and ≥3) can lead to a substantial loss of statistical power (40%-50%). Thus, when examining pain outcomes using EMA, the use of linear mixed models using the entire scale (0-10) is superior to splitting the outcomes into 2 groups (<3 and ≥3) providing greater statistical power and sensitivity.

Prevalence of depression and anxiety in a village in Sindh.

OBJECTIVE: To study the prevalence of Anxiety and Depression and its association in a rural area of Sindh, Pakistan. METHODS: A cross-sectional study was conducted at Ansari Para, in Tehsil Hala, Sindh province in Pakistan, using the Aga Khan University Anxiety and Depression Scale Urdu Version. RESULTS: Out of a total of 260 people interviewed, 112 people (43.1%) were screened to have anxiety and depression. Depression and anxiety were strongly associated with female gender, family dynamics, child environment, unsuccessful love affairs and among those with medical chronic disorders. A gradual decreasing incidence of depression and anxiety was noted with increasing level of education. A significantly strong association was noted between child mortality and maternal depression while no such association was found in males. There is a significant difference in the age of depressed and normal individuals. There was significant correlation between unhappy childhood and unsatisfying family relationships. However, no relationships were found between depression & anxiety and martial status, presence or number of children, absence of male offspring, living in joint family system, financial problems and any deficiencies that the respondents felt that he might have. CONCLUSION: This study suggests that anxiety and depression is a common psychiatric disorder even in remote village areas and contradicts the common belief that people those who live in the remote rural areas lead stress-free lives or have low rates of psychiatric morbidity.