Carroll Linda J, Cassidy J David, Côté Pierre
Department of Public Health Sciences and the Alberta Centre for Injury Control and Research, University of Alberta, 3080 RTF, 8308-114 St, Edmonton, Alta, Canada T6G 2E1.
Pain. 2004 Jan;107(1-2):134-9. doi: 10.1016/j.pain.2003.10.009.
The objective of this study is to determine whether depression is an independent risk factor for onset of an episode of troublesome neck and low back pain. There is growing evidence that pain problems increase the risk of depression. However, the evidence about the role of depression as a risk factor for onset of pain problems is contradictory. This lack of consistency in research findings may be due in part to methodological weaknesses in existing studies, for example, use of an inappropriate study design and inadequate consideration of confounding. A population-based random sample of adults was surveyed and followed at 6 and 12 months. Individuals at risk of troublesome (intense and/or disabling) neck or low back pain are the subjects of this report (n=790). We used Cox proportional hazards models to measure the time-varying effect of depressive symptoms on the onset of troublesome neck and low back pain. Our multivariable analysis considered the possible confounding effects of demographic and socio-economic factors, health status, co-morbid medical conditions and injuries to the neck or low back. We found an independent and robust relationship between depressive symptoms and onset of an episode of pain. In comparison with the lowest quartile of scores (the least depressed), those in the highest quartile of depression scores had a four-fold increased risk of troublesome neck and low back pain (adjusted HRR 3.97; 95% CI 1.81-8.72). Depression is a strong and independent predictor for the onset of an episode of intense and/or disabling neck and low back pain.
本研究的目的是确定抑郁症是否是引发颈部和下背部疼痛发作的独立危险因素。越来越多的证据表明，疼痛问题会增加患抑郁症的风险。然而，关于抑郁症作为疼痛问题发作危险因素的作用的证据相互矛盾。研究结果缺乏一致性，部分原因可能是现有研究在方法上存在缺陷，例如，使用了不恰当的研究设计以及对混杂因素考虑不足。我们对一个基于人群的成年人随机样本进行了调查，并在6个月和12个月时进行了随访。有颈部或下背部疼痛困扰（剧烈和/或致残）风险的个体是本报告的研究对象（n = 790）。我们使用Cox比例风险模型来衡量抑郁症状对颈部和下背部疼痛发作的时变效应。我们的多变量分析考虑了人口统计学和社会经济因素、健康状况、合并的医疗状况以及颈部或下背部损伤可能产生的混杂效应。我们发现抑郁症状与疼痛发作之间存在独立且显著的关系。与得分最低的四分位数（抑郁程度最低）相比，抑郁得分最高的四分位数人群出现颈部和下背部疼痛困扰的风险增加了四倍（调整后的HRR为3.97；95% CI为1.81 - 8.72）。抑郁症是剧烈和/或致残性颈部和下背部疼痛发作的一个强有力的独立预测因素。
