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(R03)”的回应。与这项计划的宣布一致，我们的目标是测试关于女性疼痛和抑郁障碍共病的发育途径的假设。临床上显著的疼痛障碍在抑郁症患者中明显更常见，特别是在女性中，她们从青春期开始更有可能同时经历疼痛和抑郁。这是一个具有相当大公共卫生意义的问题，因为经历高度疼痛的抑郁症患者会经历明显的痛苦和功能障碍，并且经常使用医疗服务。目的：本应用程序的具体目的是解决以下问题：1)在10岁和12岁时，个体对疼痛应激源的行为和生物反应是否与抑郁和损伤同时相关，这种联系是否随着青春期的进展而变得更强；2)对疼痛应激源的特定行为和生物反应模式是否可以解释10岁和12岁时抑郁和功能损伤的差异；以及3)在控制了10岁和12岁的抑郁和损伤后，10岁和12岁时对疼痛应激源的个体反应差异是否与11岁和13岁时的抑郁和损伤的个体差异存在前瞻性关联？方法：在目前由NIMH资助的一项纵向研究的背景下，女孩中青春期前抑郁的前兆(R01 MH66167)，232名9岁女孩每年接受为期5年的评估。数据是从女孩和她们的母亲那里收集的。我们已经在纵向研究中植入了疼痛刺激，即冷加压任务(CPT)，该任务在10岁时开始实施，计划在12岁时实施。我们收集了针对10岁冷加压任务的唾液，并计划在12岁时再次收集样本。目前还没有资金用于从唾液中检测皮质醇，也没有资金用于在父母R01中进行疼痛反应分析。申请R03的目的是为了获得资金，用于测试关于女性共病疼痛和抑郁的发育现象学假说，这一目标没有包括在母公司R01研究中。创新：这将是第一项探索疼痛和抑郁之间的发育界面的研究，使用对受控疼痛刺激的行为和生物反应，以及从童年开始的具有临床意义的抑郁症状测量。公共卫生相关性：临床上显著的疼痛障碍在抑郁症患者中更为常见，特别是在从青春期开始更有可能同时经历疼痛和抑郁的女性中。鉴于疼痛和抑郁并存对女性公共健康的影响，探索女孩抑郁和疼痛之间的关系的发展演变是一个重要的研究领域。这将是第一次通过对受控疼痛刺激的行为和生物学反应以及从童年开始的抑郁症状的临床有意义的测量来探索疼痛和抑郁之间的发育界面的研究。

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.