Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care.
Reciprocal relationship between pain and depression: a 12-month longitudinal analysis in primary care.
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DOI：
10.1016/j.jpain.2011.03.003
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发表时间：
2011-09
期刊：
影响因子：
--
通讯作者：
Tu W
中科院分区：
文献类型：
--
作者：
Kroenke K;Wu J;Bair MJ;Krebs EE;Damush TM;Tu W
疼痛和抑郁症分别是最常见的身体和心理疾病，30-50%的时间同时发生。然而，它们之间的相互关系和相互之间的潜在因果影响尚未得到充分研究。纵向数据分析涉及500例持续性背部、髋关节或膝关节疼痛的初级保健患者，这些患者参加了情感障碍和肌肉骨骼疼痛阶梯式护理（SCAMP）研究。一半的参与者患有共病抑郁症，并被随机分为阶梯式护理干预（n = 123）或常规治疗（n = 127）。另外250名有类似疼痛的非抑郁症患者被纳入平行队列。在基线、3、6和12个月时评估结局。进行混合效应模型重复测量（MMRM）多变量分析，以确定疼痛严重程度的变化是否可预测随后的抑郁严重程度，反之亦然。疼痛的变化是随后抑郁严重程度的强预测因子（t值= 6.63，p <0.0001）。同样，抑郁严重程度的变化是随后疼痛严重程度的同样强的预测因子（t值= 7.28，p <0.0001）。在临床试验亚组中，全队列的结果相似。总之，当在12个月内进行纵向评估时，疼痛和抑郁对彼此具有强烈和相似的影响。
Pain and depression are the most prevalent physical and psychological symptom-based disorders, respectively, and co-occur 30–50% of the time. However, their reciprocal relationship and potentially causative effects on one another have been inadequately studied. Longitudinal data analysis involving 500 primary care patients with persistent back, hip or knee pain were enrolled in the Stepped Care for Affective Disorders and Musculoskeletal Pain (SCAMP) study. Half of the participants had comorbid depression and were randomized to a stepped care intervention (n = 123) or treatment as usual (n = 127). Another 250 nondepressed patients with similar pain were followed in a parallel cohort. Outcomes were assessed at baseline, 3, 6, and 12 months. Mixed effects model repeated measures (MMRM) multivariable analyses were conducted to determine if change in pain severity predicted subsequent depression severity, and vice-versa. Change in pain was a strong predictor of subsequent depression severity (t-value = 6.63, p < .0001). Likewise, change in depression severity was an equally strong predictor of subsequent pain severity (t-value = 7.28, p < .0001). Results from the full cohort were similar in the clinical trial subgroup. In summary, pain and depression have strong and similar effects on one another when assessed longitudinally over 12 months.
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