The association between severity of depression and prescription opioid misuse among chronic pain patients with and without anxiety: A cross-sectional study
The association between severity of depression and prescription opioid misuse among chronic pain patients with and without anxiety: A cross-sectional study
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DOI：
10.1016/j.jad.2018.04.058
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发表时间：
2018-08-01
影响因子：
6.6
通讯作者：
Lev-Ran, Shaul
中科院分区：
文献类型：
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作者：
Feingold, Daniel;Brill, Silviu;Lev-Ran, Shaul
背景资料：鉴于近年来几个发达国家处方阿片类药物（PO）滥用率和相关死亡率的增加，已努力确定可能面临PO滥用风险增加的人群。虽然疼痛患者中抑郁症和PO滥用之间的关联已得到充分证明，但关于抑郁症严重程度对滥用率的影响知之甚少。在这项研究中，我们探讨了PO滥用率慢性疼痛患者筛选阳性抑郁症根据severity.Methods：参与者包括慢性疼痛患者接受PO（N = 554）。使用患者健康问卷（PHQ-9;轻度，中度，中重度和重度抑郁症的截止评分分别为5，10，15和20）筛选所有参与者的抑郁症，并使用当前阿片类药物滥用测量（COMM）筛选阿片类药物滥用。Logistic回归分析控制额外的社会人口统计学和临床factors carried.Results：参与者筛选抑郁症阳性显着增加的赔率，筛选阳性阿片类药物滥用（调整后的比值比（AOR）= 3.63; 95%置信区间（CI）= 1.71-7.7）相比，那些没有抑郁症。抑郁症的严重程度与中度阿片类药物滥用的几率增加显著相关。（AOR = 3.71; 95% CI = 1.01-13.76），中重度（AOR = 6.28; 95% CI = 1.6-24.57）和重度（AOR = 14.66; 95%CI = 3.28-65.52）抑郁，但在轻度抑郁筛查阳性者中没有（AOR = 1.49; 95%CI = 0.39-5.68）.局限性：横断面研究.结论：我们的研究结果强调需要正确评估和解决接受PO的慢性疼痛患者中共病抑郁的严重程度。
Background: In light of the increased rates of Prescription Opioid (PO) misuse and associated mortality in several developed countries in recent years, efforts have been made to identify populations who may be at increased risk for misuse of POs. Though the association between depression and PO misuse among pain patients is well documented, little is known regarding the effects of severity of depression on rates of misuse. In this study we explored rates of PO misuse among chronic pain patients screening positive for depression according to level of severity.Methods: Participants included chronic pain patients receiving POs (N = 554). All participants were screened for depression using the Patient Health Questionnaire (PHQ-9; cut-off scores of 5, 10, 15, and 20 for mild, moderate, moderate-severe and severe depression, respectively) and for opioid misuse using the Current Opioid Misuse Measure (COMM). Logistic regression analyses controlling for additional sociodemographic and clinical factors were conducted.Results: Participants who screened positive for depression were at significantly increased odds to screen positive for opioid misuse (Adjusted Odds Ratio (AOR) = 3.63; 95% Confidence Interval (CI) = 1.71-7.7) compared to those without depression. Severity of depression was significantly associated with increased odds for opioid misuse for moderate (AOR = 3.71; 95% CI = 1.01-13.76), moderate-severe (AOR = 6.28; 95% CI = 1.6-24.57) and severe (AOR = 14.66; 95% CI = 3.28-65.52) depression but not among those who screened positive for mild depression (AOR = 1.49; 95% CI = 0.39-5.68).Limitations: Cross-sectional study.Conclusions: Our results highlight the need to properly asses and address level of severity of co-morbid depression among chronic pain patients receiving POs.