Persistent depressive symptoms and pain after cardiac surgery.
Persistent depressive symptoms and pain after cardiac surgery.
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DOI：
10.1097/psy.0000000000000074
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发表时间：
2014-07
影响因子：
3.3
通讯作者：
Irwin MR
中科院分区：
文献类型：
--
作者：
Doering LV;Chen B;McGuire A;Bodán RC;Irwin MR
我们的目的是描述出院时和六周后抑郁症状和疼痛的轨迹，并检查持续抑郁症状与疼痛的关系。251例心脏手术患者（年龄67.3±9.5岁，男性73%）在出院前和出院后6周完成贝克抑郁量表（BDI）和短暂疼痛量表（BPI）。根据是否存在持续性抑郁症状（两次均为BDI bbb10）将患者分为两组。采用重复测量方差分析评估疼痛干扰（BPI-INT）和疼痛严重程度（BPI-SEV）组间差异。采用线性回归来确定抑郁症状的改变是否与BPI-INT和BPI-SEV相关，并控制人口统计学和临床数据。出院后6周抑郁症状持续（16.3%）或加重（15.3%）；许多患者至少经历了一些持续性疼痛（BPI-INT - 67.8%; BPI-SEV - 47.8%）。从出院到6周，持续抑郁症状的患者BPI-INT （p< 0.001）和BPI-SEV （p< 0.003）水平持续升高。在多变量分析中，只有抑郁症状的变化与BPI-INT （p< 0.001）和BPI-SEV （p= 0.001）相关，而与临床和人口统计学变量无关。持续抑郁症状与出院后6周的持续疼痛独立相关。持续疼痛的成功治疗应包括抑郁症状的筛查和适当治疗的开始。
Our objectives were to describe trajectories of depressive symptoms and pain at hospital discharge and six weeks later and to examine the relationship of persistent depressive symptoms to pain. Before and six weeks after hospital discharge, 251 cardiac surgery patients (aged 67.3 ± 9.5 years; 73% male) completed the Beck Depression Inventory (BDI) and the Brief Pain Inventory (BPI). Patients were categorized into two groups based on the presence or absence of persistent depressive symptoms (BDI>10 at both times). Between-group differences in pain interference (BPI-INT) and pain severity (BPI-SEV) were evaluated using repeated measures analysis of variance. Linear regressions were performed to determine if changes in depressive symptoms were related to BPI-INT and BPI-SEV, controlling for demographic and clinical data. Persistent (16.3%) or worsening depressive symptoms (15.3%) from hospital discharge to six weeks were observed; many experienced at least some persistent pain (BPI-INT - 67.8%; BPI-SEV - 47.8%). From discharge to six weeks, patients with persistent depressive symptoms sustained higher levels of BPI-INT (p<.001) and BPI-SEV (P<.003). In multivariate analysis, only changes in depressive symptoms, not clinical and demographic variables, were related to BPI-INT (p<.001) and BPI-SEV (p=.001). Persistent depressive symptoms are independently associated with continued pain up to six weeks after hospital discharge. Successful treatment of ongoing pain should include screening for depressive symptoms and initiation of appropriate treatment.