Dohrenwend B P, Raphael K G, Marbach J J, Gallagher R M
Columbia University, 100 Haven Ave., Tower III-19E, New York, NY 10032, USA.
Pain. 1999 Nov;83(2):183-92. doi: 10.1016/s0304-3959(99)00100-1.
A number of explanations have been proposed to account for findings that rates of depression are elevated in persons with chronic, non-malignant pain disorders (CNPDs); for example, that CNPDs are variants of depression (e.g. 'masked depression'), that the stress of living with CNPDs contribute to the onset of depression ('diathesis-stress'), or that the correlation of CNPDs and depression is a methodological artifact of studying treatment-seeking samples. These alternative hypotheses are tested for one specific CNPD, chronic myofascial face pain, using a family study methodology. The procedure was to conduct direct psychiatric interviews with 106 patients with a history of carefully diagnosed myofascial face pain, 118 acquaintance controls without personal histories of myofascial face pain, and a random sample of adult first degree relatives of these case and control probands. The probands were further subdivided into four roughly equal samples consisting of cases with and without personal histories of major depressive disorder (MDD), and controls with and without personal histories of MDD. Dates of initial onsets of myofascial face pain and MDD in patient probands were obtained from interviews and records. The main results were that, compared to control probands without personal histories of MDD, MDD and depressive spectrum disorders (DSD) were elevated in the first degree relatives of control probands with personal histories of early onset MDD, but not in the first degree relatives of myofascial face pain probands with or without personal histories of early or late onset MDD. This outcome is consistent with the hypothesis that living with chronic myofascial face pain contributes to elevated rates of depression. It is inconsistent with the alternative hypotheses that this CNPD is a variant of depression or that the elevated MDD rates are simply an artifact of selection into treatment. The implications of these results and additional results consistent with them are discussed.
针对慢性非恶性疼痛障碍（CNPDs）患者中抑郁症发病率升高这一现象，人们提出了多种解释；例如，认为CNPDs是抑郁症的变体（如“隐匿性抑郁症”），与CNPDs共存的压力会导致抑郁症的发作（“素质-应激”），或者认为CNPDs与抑郁症之间的相关性是研究寻求治疗样本时的一种方法学假象。本研究采用家族研究方法，对一种特定的CNPD——慢性肌筋膜面部疼痛进行了这些替代假设的检验。具体做法是，对106名有明确诊断的肌筋膜面部疼痛病史的患者、118名无肌筋膜面部疼痛个人病史的熟人对照，以及这些病例和对照先证者的成年一级亲属随机样本进行直接的精神病学访谈。先证者进一步细分为四个大致相等的样本，包括有和没有重度抑郁症（MDD）个人病史的病例，以及有和没有MDD个人病史的对照。患者先证者中肌筋膜面部疼痛和MDD的初始发病日期通过访谈和记录获得。主要结果是，与无MDD个人病史的对照先证者相比，有早发性MDD个人病史的对照先证者的一级亲属中MDD和抑郁谱系障碍（DSD）发病率升高，但有或没有早发或晚发MDD个人病史的肌筋膜面部疼痛先证者的一级亲属中则没有升高。这一结果与慢性肌筋膜面部疼痛会导致抑郁症发病率升高的假设一致。它与以下替代假设不一致，即这种CNPD是抑郁症的变体，或者MDD发病率升高仅仅是选择接受治疗的假象。本文讨论了这些结果以及与它们一致的其他结果的意义。
