This study aimed to: (1) determine prevalence of depression in patients referred to specialist pain services using the Structured Clinical Interview (SCID) diagnostic interview, (2) compare results on the Beck Depression Inventory II (BDI-II) with the SCID to determine the utility of the BDI-II as a screening tool in this population. Thirty-six participants were recruited, mainly women, with a mean age = 47.83 years (standard deviation = 12.85 years), who were heterogeneous with regard to their pain. All completed the BDI-II and SCID. The SCID diagnosed 26 (72%) cases of depression. BDI-II scores showed 31 (86%) that reported at least mild depression. Agreement between BDI-II scores over threshold for mild depression and SCID diagnosis were assessed by Cohen's kappa (= 0.6). ROC analysis for BDI-II scores against SCID diagnosis gave a large area under the curve (0.97, 95% confidence interval 0.93 to 1.02), suggesting BDI-II is an excellent screen for this population, although the curve was unusual in that sensitivity was high even when the false positive rate was zero. ROC analysis suggested 22 or above as an optimum cut-off score for depression on the BDI-II-higher than for a general population sample. It has been suggested that the BDI overestimates incidence of depression in pain patients, but this study confirmed through diagnostic interview the very high incidence of depression in this population. It is therefore questionable whether there is value in screening referrals for depression. When using BDI-II for screening, audit or evaluation purposes with a pain clinic population, we suggest a cut-off of 22 or above.

The relationship of our emotions and psyche to heart disease is intriguing. In this article we have reviewed the evidence linking cardiovascular and neuropsychiatric disorders and the possible mechanisms and pathophysiology of this association. This review is derived from Medline searches (1966–2002) using the relevant search terms (psychiatric disease, cardiovascular disease, depression, anxiety, and pathophysiology). Finally, the possible role of using mood enhancing therapies (mainly antidepressants) and their safety in patients with cardiovascular disorders is briefly discussed. In a companion paper, the therapeutic aspects of these two conditions is highlighted.

There is a plausible biological basis for the association between psychiatric morbidity and cardiovascular disease. Anxiety, panic disorder, and depression are common in patients with coronary heart disease and hypertension. Despite this evidence there is poor recognition of anxiety disorders and depression in primary care and hospital medical practice. Concern also surrounds the use of psychotropic drugs in patients with cardiovascular disease. In the first of the two articles on this subject, we highlighted the current evidence regarding the association between cardiovascular and psychotropic conditions. In this second article, we discuss the interaction of the drugs used in the management of these two varied but commonly coexistent group of diseases as well as their relative effects on either system. Finally, we summarise the data regarding the safe use of these medications based on the recommendations from the currently available evidence.

Background: Individual characteristics such as gender, employment and age have been shown to predict attendance at pain management services (PMS). The characteristics of those who drop out of pain management programmes have also been explored, but as yet no studies have analysed the characteristics of those who do not attend the service following referral. Purpose: To explore the characteristics and predictors of those who attend and those who do not attend their first appointment with a PMS. Method: Predictive factors in the two groups – attenders ( n = 425) and non-attenders ( n = 69) – were explored using logistic regression. Results: Non-attendance was significantly predicted by the patient being a smoker and the appointment being in the morning. Non-attenders also scored higher on the Modified Somatic Perception Questionnaire, indicating higher levels of somatic pain. Discussion: Predictors of non-attendance were different from those for individuals who drop out of pain services. Implications and recommendations are made for PMS.

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We describe a novel psychology service providing assessment and brief intervention to clients in psychological crisis presenting to Accident and Emergency.