Pain and the onset of depressive and anxiety disorders
Pain and the onset of depressive and anxiety disorders
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DOI：
10.1016/j.pain.2013.09.005
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发表时间：
2014-01-01
期刊：
影响因子：
7.4
通讯作者：
van der Horst, Henritte E.
中科院分区：
文献类型：
--
作者：
Gerrits, Marloes M. J. G.;van Oppen, Patricia;van der Horst, Henritte E.
疼痛患者可能会增加患抑郁症或焦虑症首次发作的风险。深入了解特定疼痛特征与这种发展之间可能的关联可以帮助临床医生改善预防和治疗策略。本研究的目的是检查疼痛病理学对抑郁和焦虑发作的影响，并确定这些协会是否独立于阈下抑郁和焦虑症状。研究使用了2004年至2011年荷兰抑郁和焦虑研究的数据。共有614名参与者没有既往病史，基线时没有抑郁或焦虑，随访4年。在2年和4年随访时，通过复合国际诊断访谈评估抑郁或焦虑障碍的发作。基线疼痛特征为位置、持续时间和严重程度，通过慢性疼痛分级进行评估。15.5%的参与者出现抑郁或焦虑障碍。使用考克斯生存分析，抑郁和焦虑的发作与6个疼痛部位（颈部、背部、头部、口面部、腹部和关节;风险比[HR] = 1.96至4.02; P <0.05）、疼痛部位数量增加（HR = 1.29; P <0.001）和疼痛严重程度增加（HR = 1.57; P <0.001）相关。相比之下，与疼痛症状的持续时间无关（HR = 1.47; P = 0.12）。独立于阈下情感症状，只有关节疼痛和疼痛部位的增加仍然与抑郁和焦虑发作显著相关。临床医生应该意识到，无论情感症状如何，疼痛，特别是多个部位的疼痛，都是发展抑郁症和焦虑症的风险指标。(C)2013年国际疼痛研究协会。Elsevier B. V.出版，保留所有权利。
Patients with pain may be at increased risk of developing a first episode of depressive or anxiety disorder. Insight into possible associations between specific pain characteristics and such a development could help clinicians to improve prevention and treatment strategies. The objectives of this study were to examine the impact of pain symptomatology on depression and anxiety onset and to determine whether these associations are independent of subthreshold depressive and anxiety symptoms. Data from the Netherlands Study of Depression and Anxiety, collected between 2004 and 2011, were used. A total of 614 participants with no previous history and no current depression or anxiety at baseline were followed up for 4 years. Onset of depressive or anxiety disorder was assessed at 2- and 4-year follow-up by Composite International Diagnostic Interview. Baseline pain characteristics were location, duration, and severity, as assessed by chronic pain grade. Onset of depressive or anxiety disorder occurred in 15.5% of participants. Using Cox survival analyses, onset of depression and anxiety was associated with 6 pain locations (neck, back, head, orofacial area, abdomen, and joints; hazard ratio [HR] = 1.96 to 4.02; P < .05), increasing number of pain locations (HR = 1.29; P < .001), and higher severity of pain (HR = 1.57; P < .001). By contrast, there was no association with duration of pain symptoms (HR = 1.47; P = .12). Independent of subthreshold affective symptoms, only joint pain and increasing number of pain locations were still significantly associated with depression and anxiety onset. Clinicians should be aware that regardless of affective symptoms, pain, particularly at multiple locations, is a risk indicator for developing depressive and anxiety disorders. (C) 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.