Developmental comorbidity of pain and depression in preadolescent girls

描述（由申请人提供）：修订后的申请是对PA-06-543，“疼痛研究中的机制、模型、测量和管理（R 03）”的回应。“与此计划公告一致，我们的目标是测试关于女性共病疼痛和抑郁障碍的发展途径的假设。具有临床意义的疼痛障碍在抑郁症患者中明显更为常见，尤其是在女性中，她们更容易从青春期开始经历疼痛和抑郁。这是一个具有相当大的公共卫生意义的问题，因为经历高水平疼痛的抑郁症患者会经历明显的痛苦和功能障碍，并且是医疗服务的频繁消费者。目的：本申请的具体目标是解决以下问题：1）对疼痛应激源的行为和生物反应的个体差异是否与10岁和12岁时的抑郁和损伤同时相关，并且这种关联是否随着青春期的进展而变得更强;（二）对疼痛压力源的行为和生物反应的特定模式是否能解释10岁和15岁时抑郁和功能障碍的差异？12人;在控制了10岁和12岁时的抑郁和损伤后，10岁和12岁时对疼痛应激源反应的个体差异是否与11岁和13岁时抑郁和损伤的个体差异有前瞻性相关？方法：在目前由NIMH资助的一项纵向研究的背景下，女孩抑郁症的青春前期前兆（R 01 MH 66167），每年对232名9岁女孩进行为期5年的评估。数据是从女孩和她们的母亲那里收集的。我们在纵向研究中嵌入了疼痛刺激，冷加压任务（CPT），在10岁时进行，计划在12岁时进行。我们已经收集了10岁CPT的唾液，并计划在12岁时再次收集样本。没有资金用于测定唾液中的皮质醇或对母体R 01的疼痛反应进行分析。R 03申请的目的是确保用于测试女性共病疼痛和抑郁症的发育现象学假设的资金，这一目的未纳入母R 01研究。创新：这将是第一项研究，探讨疼痛和抑郁症之间的发展界面，使用行为和生物反应控制疼痛刺激和临床意义的措施，抑郁症状开始在童年。公共卫生相关性：具有临床意义的疼痛障碍在抑郁症患者中更为常见，特别是在女性中，她们更有可能从青春期开始经历疼痛和抑郁症。鉴于疼痛和抑郁症共同发生对女性公共健康的影响，探索女孩抑郁症和疼痛之间关系的发展演变是一个重要的研究领域。这将是第一项研究，探讨疼痛和抑郁症之间的发展界面，使用行为和生物反应控制疼痛刺激和临床意义的措施，抑郁症状开始在童年。

DESCRIPTION (provided by applicant): The revised application is in response to PA-06-543, "Mechanisms, Models, Measurement, & Management in Pain Research (R03)." Consistent with this program announcement, we aim to test hypotheses about the developmental pathways to comorbid pain and depressive disorders in females. Clinically significant pain disorders are markedly more common in individuals with depression, particularly in females who are more likely to experience both pain and depression from adolescence on. This is an issue of considerable public health significance, as depressed individuals who experience high levels of pain experience marked distress and functional impairment and are frequent consumers of medical services. Aims: The specific aims for this application are to address the following questions: 1) Are individual differences in behavioral and biological response to a pain stressor concurrently associated with depression and impairment at ages 10 and 12 and does this association grow stronger as puberty progresses; 2) Do specific patterns of behavioral and biological response to a pain stressor explain variance in depression and functional impairment at ages 10 and 12; and 3) Are individual differences in response to a pain stressor at ages 10 and 12 prospectively associated with individual differences in depression and impairment at ages 11 and 13, after controlling for depression and impairment at ages 10 and 12? Approach: In the context of a longitudinal study currently funded by NIMH, Preadolescence precursors to depression in girls (R01 MH66167), 232 nine-year old girls are being assessed annually for a period of 5 years. Data are collected from both the girls and their mothers. We have embedded a pain stimulus into the longitudinal study, the cold pressor task (CPT), which was administered at age 10 and is planned for administration at age 12. We have collected saliva in response to the CPT age 10 and plan to collect samples again at age 12. There are no funds for assaying cortisol from the saliva or for conducting analyses on pain response in the parent R01. The purpose of this application for an R03 is to secure funding for testing hypotheses about the developmental phenomenology of comorbid pain and depression in females, an aim that was not included in the parent R01 study. Innovation: This will be the first study to explore the developmental interface between pain and depression using behavioral and biological responses to a controlled pain stimulus and clinically meaningful measures of depressive symptoms beginning in childhood. PUBLIC HEALTH RELEVANCE: Clinically significant pain disorders are much more common in individuals with depression, particularly in females who are more likely to experience both pain and depression from adolescence on. Given the impact of co-occurring pain and depression on public health for females especially, probing the developmental unfolding of the relations between depression and pain in girls is an important area of research. This will be the first study to explore the developmental interface between pain and depression using behavioral and biological responses to a controlled pain stimulus and clinically meaningful measures of depressive symptoms beginning in childhood.