Taylor Renae, Lovibond Peter F, Nicholas Michael K, Cayley Carol, Wilson Peter H
School of Psychology, University of New South Wales, Sydney, Australia.
Clin J Pain. 2005 Jan-Feb;21(1):91-100. doi: 10.1097/00002508-200501000-00011.
To investigate the role of somatic items in the assessment of depression in chronic pain.
The Self-Rating Depression Scale was administered to 398 individuals with chronic pain, 313 psychology clinic patients with similar overall levels of depression, and a general population sample of 491. All three samples were also administered the Depression Anxiety Stress Scales.
Confirmatory factor analysis of pooled Self-Rating Depression Scale and Depression Anxiety Stress Scales items revealed that Self-Rating Depression Scale items denoting diurnal variation, decreased appetite, weight loss and constipation failed to contribute to depression in all 3 samples. Items denoting tachycardia and irritability also failed to discriminate between depression and a combined anxiety/stress factor in all 3 samples. The chronic pain sample endorsed somatic items, in particular psychomotor retardation, sleep disturbance, constipation, and fatigue, more strongly than the other samples relative to their endorsement of nonsomatic depression items.
It was concluded that depression measures that give emphasis to somatic symptoms provide poor measures of depression severity in any individuals and in patients with chronic pain may lead to an overestimation of the severity of depression. More recently developed instruments avoid these limitations and are also better able to discriminate depression from related states such as anxiety and tension/stress.
探讨躯体症状在慢性疼痛患者抑郁评估中的作用。
对398名慢性疼痛患者、313名抑郁总体水平相似的心理门诊患者以及491名普通人群样本进行自评抑郁量表测试。所有三个样本还进行了抑郁焦虑压力量表测试。
对自评抑郁量表和抑郁焦虑压力量表合并项目的验证性因素分析表明，自评抑郁量表中表示昼夜变化、食欲减退、体重减轻和便秘的项目在所有三个样本中均未对抑郁有贡献。表示心动过速和易怒的项目在所有三个样本中也未能区分抑郁与合并的焦虑/压力因素。与其他样本对非躯体性抑郁项目的认可相比，慢性疼痛样本对躯体症状项目，特别是精神运动迟缓、睡眠障碍、便秘和疲劳的认可更为强烈。
得出的结论是，强调躯体症状的抑郁测量方法在任何个体中对抑郁严重程度的测量效果都很差，在慢性疼痛患者中可能会导致对抑郁严重程度的高估。最近开发的工具避免了这些局限性，并且也能更好地将抑郁与焦虑和紧张/压力等相关状态区分开来。
