The Adverse Effects of Comorbid Pain on Depression Outcomes in Primary Care Patients: Results from the Artist Trial
The Adverse Effects of Comorbid Pain on Depression Outcomes in Primary Care Patients: Results from the Artist Trial
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DOI：
10.1111/j.1526-4637.2010.00830.x
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发表时间：
2010-01-01
期刊：
影响因子：
3.1
通讯作者：
Kroenke, Kurt
中科院分区：
文献类型：
--
作者：
DeVeaugh-Geiss, Angela M.;West, Suzanne L.;Kroenke, Kurt
目的：探讨疼痛症状和疼痛改善对抑郁结果的影响。方法：我们分析了一项研究SSRI治疗的随机试验(RAIT)的数据，这是一项比较选择性5-羟色胺再摄取抑制剂(SSRI)在初级保健中治疗抑郁症的随机纵向有效性研究(n=573)。结果：与基线时无疼痛的患者相比，重度疼痛的患者获得缓解(OR=0.11，95%CI 0.05~0.25)和部分应答(OR=0.24，95%CI 0.10~0.59)的可能性较小。中度疼痛患者缓解的可能性低于无反应患者(OR=0.25，95%CI为0.13~0.48)。早期疼痛改善的患者更有可能获得缓解(OR=1.90，95%CI为1.03~3.49)。结论：大多数开始接受抗抑郁药物治疗的抑郁症初级保健患者存在明显的症状。疼痛症状与较差的抑郁结果相关，而疼痛的改善与明显较好的抑郁结果相关。关注并存的疼痛可能是加强抑郁症护理的重要因素。
Objectives.To explore the effect of pain symptoms and improvements in pain on depression outcomes.Methods.We analyzed data from A Randomized Trial Investigating SSRI Treatment (ARTIST), a randomized longitudinal effectiveness study comparing selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression in primary care (n = 573). Depression outcome at month 6, defined as remission, partial response, and nonresponse using the Symptom Checklist-20, was the primary outcome.Results.Compared to patients with no pain at baseline, those with severe pain were less likely to achieve remission (OR = 0.11, 95% CI 0.05-0.25) and partial response (OR = 0.24, 95% CI 0.10-0.59) vs nonresponse. Patients with moderate pain were less likely to achieve remission vs nonresponse (OR = 0.25, 95% CI 0.13-0.48). Patients with early improvement in pain were more likely to achieve remission (OR = 1.90, 95% CI 1.03-3.49). Accounting for missing data with last observation carried forward or multiple imputation yielded similar results.Conclusion.Pain symptoms are present in the majority of depressed primary care patients beginning antidepressant therapy. Pain symptoms are associated with worse depression outcomes, while improvement in pain is associated with significantly better depression outcomes. Attention to comorbid pain may be important in enhancing depression care.