Morley Stephen, Williams Amanda C de C, Black Stephanie
Academic Unit of Psychiatry and Behavioural Sciences, School of Medicine, University of Leeds, Leeds, LS2 9 JT, UK.
Pain. 2002 Sep;99(1-2):289-98. doi: 10.1016/s0304-3959(02)00137-9.
The Beck Depression Inventory (BDI) is widely used to assess depression in chronic pain despite doubts about its structure and therefore its interpretation. This study used a large sample of 1947 patients entering chronic pain management to establish the structure of the BDI. The sample was randomly divided to conduct separate exploratory (EFA) and confirmatory factor analyses (CFA). EFA produced many satisfactory two-factor solutions. The series of CFA generated showed reasonable fit for ten of those solutions. All included a first factor identified as negative view of the self (items: failure, guilt, self-blame, self-dislike, punishment and body image change), and a second factor identified as somatic and physical function (items: work difficulty, loss of appetite, loss of libido, fatigability, insomnia and somatic preoccupation). The remaining items (suicidal ideation, social withdrawal, dissatisfaction, sadness, pessimism, crying, indecisiveness, weight loss, irritability) loaded infrequently or not at all in the CFA solutions. They did not form a coherent factor but comprised items associated with negative affect. When compared with published data from samples of depressed patients drawn from mental health settings the mean item scores for items reflecting the negative view of the self were consistently statistically lower that that observed in samples; there was no consistent difference between the samples on the items reflecting somatic and physical function; but the mean scores for the remaining affect items were significantly greater in the mental health samples. This version of depression is strikingly different from the psychiatric model of depression (e.g. DSM-IV or ICD-10), which is primarily defined by affective disturbance, and secondarily supported by cognitive and somatic symptoms. The finding is consistent with a reconsideration of what constitutes depression in the presence of chronic pain. It also has important clinical implications: it may provide a way to distinguish depressed patients with typical cognitive biases, who require specific treatment for depression alongside pain management.
贝克抑郁量表（BDI）尽管在结构及其解释方面存在疑问，但仍被广泛用于评估慢性疼痛患者的抑郁情况。本研究采用了1947名进入慢性疼痛管理项目的患者的大样本，以确定BDI的结构。样本被随机分为两组，分别进行探索性因素分析（EFA）和验证性因素分析（CFA）。EFA得出了许多令人满意的双因素解决方案。一系列CFA结果显示，其中十种解决方案具有合理的拟合度。所有解决方案都包含一个被确定为对自我的负面看法的第一因素（项目：失败、内疚、自责、自我厌恶、惩罚和身体形象改变），以及一个被确定为躯体和身体功能的第二因素（项目：工作困难、食欲不振、性欲减退、易疲劳、失眠和躯体关注）。其余项目（自杀意念、社交退缩、不满、悲伤、悲观、哭泣、犹豫不决、体重减轻、易怒）在CFA解决方案中很少或根本没有载荷。它们没有形成一个连贯的因素，而是包含与负面情绪相关的项目。与从心理健康机构抽取的抑郁症患者样本的已发表数据相比，反映对自我负面看法的项目平均得分在统计学上始终低于样本中观察到的得分；在反映躯体和身体功能的项目上，样本之间没有一致的差异；但心理健康样本中其余情绪项目的平均得分明显更高。这种抑郁版本与主要由情感障碍定义、其次由认知和躯体症状支持的抑郁症精神科模型（如DSM-IV或ICD-10）显著不同。这一发现与重新考虑慢性疼痛情况下抑郁症的构成是一致的。它也具有重要的临床意义：它可能提供一种方法来区分具有典型认知偏差的抑郁症患者，这些患者除了疼痛管理外还需要针对抑郁症的特定治疗。
