The longitudinal occurrence and impact of comorbid chronic pain and chronic depression over two years in continuing care retirement community residents
The longitudinal occurrence and impact of comorbid chronic pain and chronic depression over two years in continuing care retirement community residents
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DOI：
10.1111/j.1526-4637.2004.04041.x
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发表时间：
2004-12-01
期刊：
影响因子：
3.1
通讯作者：
Gallagher, RM
中科院分区：
文献类型：
--
作者：
Mossey, JM;Gallagher, RM
Objective.描述持续护理退休社区（CCRC）居民经历的抑郁症状和疼痛的纵向过程，并调查共病慢性活动限制性疼痛和慢性高度抑郁症状对身体功能和卫生服务使用的影响。这项对169名CCRC居民的纵向研究涉及五项评估（基线和四次面对面访谈，间隔6个月）。老年抑郁量表（GDS），麦吉尔疼痛问卷的问题，和自我报告的身体功能和医疗保健使用的数据进行了评估。报告活动限制性疼痛的个体和在三次或三次以上评估中GDS评分大于或等于11的个体分别被认为患有慢性疼痛或慢性抑郁。分析样本包括169名CCRC居民。采用多因素Logistic回归对假设进行检验。疼痛和抑郁症状的特点是纵向稳定性。在样本中，37%符合慢性活动限制性疼痛的标准，21%符合慢性高度抑郁症状的标准，13%为共病。根据年龄和健康状况进行调整后，患有慢性活动限制性疼痛的人比最低疼痛组的人持续处于身体功能最差的两个四分位数的可能性高出五倍，即使是GDS评分>5的人也是如此。患有慢性疼痛和抑郁症的患者身体机能不良的几率是患有慢性疼痛和抑郁症的患者的11.2倍。在该样本中，医疗护理就诊频率（调整后的比值比[AOR]=12.4）和所有医疗服务的持续高使用率（AOR=3.5）的比值相对较大。疼痛和抑郁症状都很常见，并且随着时间的推移表现得非常稳定。抑郁症状对疼痛相关损害的预测有显著贡献，识别和治疗这些症状，即使是轻微的症状，也可以减少老年人疼痛相关损害和医疗保健费用。
Objective. To describe the longitudinal course of depressive symptoms and pain experienced by continuing care retirement community (CCRC) residents and to investigate the impact of comorbid chronic activity-limiting pain and chronic high depressive symptoms on physical functioning and health service use.Methods. This longitudinal study of 169 CCRC residents involved five assessments (baseline and four in-person interviews at 6-month intervals). The Geriatric Depression Scale (GDS), questions drawn from the McGill Pain Questionnaire, and self-report data on physical functioning and health care use were assessed. Individuals reporting activity-limiting pain and those with GDS scores greater than or equal to11 at three or more assessments were considered to have chronic pain or chronic depression, respectively. The analysis sample included 169 CCRC residents. Multivariate logistic regression was used to test hypotheses.Results. Pain and depressive symptoms were characterized by longitudinal stability. Of the sample, 37% met the criteria for chronic activity-limiting pain, 21% met the criteria for chronic high depressive symptoms, and 13% were comorbid. Adjusting for age and health conditions, those with chronic activity-limiting pain were five times more likely than those in the lowest pain group to persistently be in the worst two quartiles of physical functioning, as were those with even one GDS score >5. The odds of poor physical functioning were 11.2 times greater in those with comorbid chronic pain and depression. Comparable greater odds were seen in this sample for frequency of medical care visits (adjusted odds ratio [AOR]=12.4) and consistently high use of all medical services (AOR=3.5).Conclusions. Pain and depressive symptoms were both common and appeared remarkably stable over time. Depressive symptoms contributed significantly to the prediction of impairment associated with pain, and identification and treatment of such symptoms, even minor symptoms, could reduce pain-related impairment and health care costs in the elderly.