{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:00:35Z","timestamp":1790280035634,"version":"4.1.0"},"reference-count":47,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T00:00:00Z","timestamp":1779926400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"UK Prevention Research Partnership","award":["MR-VO49879\/1"],"award-info":[{"award-number":["MR-VO49879\/1"]}]},{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","award":["MR\/W014386"],"award-info":[{"award-number":["MR\/W014386"]}],"id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"name":"NIHR Advanced Fellowship"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["British Journal of Pain"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic pain (CP) and severe mental illness (SMI) frequently co-occur, exacerbating clinical outcomes and healthcare burden. The influence of diagnostic sequence, that is, whether CP precedes SMI or vice versa, on mental health and hospitalization remains underexplored. This study investigates how the temporal order of CP and SMI diagnoses impacts illness burden, mental health comorbidities, and hospital admissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Using linked electronic health records from primary care, mental health, and acute care in South London, we identified 1112 patients with comorbid CP and SMI (e.g. schizophrenia). Patients were grouped by diagnostic order: CP before SMI (CP-SMI,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 413) versus SMI before CP (SMI-CP,\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 699). Outcomes included illness burden, mental health comorbidities, and hospital admissions, which were analysed via multivariable regression, adjusting for confounders.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Compared to the CP-SMI group, the SMI-CP group exhibited significantly lower odds of self-injury (OR = 0.55, 95% CI: 0.31\u20130.98), substance misuse (OR = 0.55, 95% CI: 0.34\u20130.86), depressive mood (OR = 0.63, 95% CI: 0.44\u20130.89), and depression diagnosis (OR = 0.58, 95% CI: 0.43\u20130.78). Among the SMI-CP group, older age reduced the odds of self-injury, substance misuse, and depressive mood but increased the risks of cognitive and physical problems. No significant differences were observed in psychiatric or general hospital admissions or physical comorbidities, though ethnic disparities persisted in psychiatric admissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Patients diagnosed with CP before SMI experience worse mental health outcomes. This is likely due to delayed psychiatric intervention, therefore routine psychiatric screening aiming to improve outcomes and reduce healthcare burden at CP diagnosis should be evaluated.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20494637261451733","type":"journal-article","created":{"date-parts":[[2026,5,28]],"date-time":"2026-05-28T12:02:57Z","timestamp":1779969777000},"page":"310-325","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic sequence of chronic pain and severe mental illness: Relationship with mental health and hospitalization outcomes"],"prefix":"10.1177","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6051-8093","authenticated-orcid":false,"given":"Ruimin","family":"Ma","sequence":"first","affiliation":[{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eugenia","family":"Romano","sequence":"additional","affiliation":[{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Ashworth","sequence":"additional","affiliation":[{"name":"King\u2019s College London"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nilufar","family":"Mossaheb","sequence":"additional","affiliation":[{"name":"Medical University of Vienna"},{"name":"Medical University of Vienna"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerem","family":"B\u00f6ge","sequence":"additional","affiliation":[{"name":"Department of Neuroscience and Psychiatry, Universit\u00e4tsmedizin Berlin, corporate member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Berlin, Germany"},{"name":"Medical University Brandenburg-Theodor Fontane"},{"name":"German Center of Mental Health (DZPG), Berlin\/Potsdam, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davy","family":"Vancampfort","sequence":"additional","affiliation":[{"name":"KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium"},{"name":"Leuven Brain Institute, Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Stewart","sequence":"additional","affiliation":[{"name":"King\u2019s College London"},{"name":"Mental Health for Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendon","family":"Stubbs","sequence":"additional","affiliation":[{"name":"King\u2019s College London"},{"name":"Medical University of Vienna"},{"name":"Medical University of Vienna"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,5,28]]},"reference":[{"key":"e_1_3_6_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000001939"},{"key":"e_1_3_6_3_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2015-010364"},{"key":"e_1_3_6_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/wps.20420"},{"key":"e_1_3_6_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(15)00505-2"},{"key":"e_1_3_6_6_2","doi-asserted-by":"publisher","DOI":"10.1111\/acps.12325"},{"key":"e_1_3_6_7_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2014.10.017"},{"key":"e_1_3_6_8_2","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2025.10074"},{"key":"e_1_3_6_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2023.11.004"},{"key":"e_1_3_6_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000542"},{"key":"e_1_3_6_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(19)30132-4"},{"key":"e_1_3_6_12_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-018-0872-4"},{"key":"e_1_3_6_13_2","doi-asserted-by":"publisher","DOI":"10.1124\/pr.113.008144"},{"key":"e_1_3_6_14_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0035302"},{"key":"e_1_3_6_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pain.2007.11.007"},{"key":"e_1_3_6_16_2","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-013-0421-0"},{"key":"e_1_3_6_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2016.08.007"},{"key":"e_1_3_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2017.07.005"},{"key":"e_1_3_6_19_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0111682"},{"key":"e_1_3_6_20_2","first-page":"4","article-title":"Depression: relationship to somatization and chronic medical illness","volume":"45","author":"Katon W","year":"1984","unstructured":"Katon W. 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