Dilsaver Steven C, Wu Xionghua, Akiskal Hagop S, Manning J Sloan
Mental Health and Mental Retardation Clinic, Rio Grande City, Texas, USA.
Prim Care Companion J Clin Psychiatry. 2005;7(4):150-4. doi: 10.4088/pcc.v07n0402.
To ascertain the frequencies of 4 prospectively determined pain complaints among adolescents meeting the criteria for major depressive episode (MDE) relative to non-affectively ill controls.
In a community mental health clinic for the indigent situated on the border of the United States and Mexico (Rio Grande City, Tex.), adolescents (age range, 12-17 years) who consecutively presented to the clinic from August 2001 to November 2003 received structured psychiatric diagnostic screens for depression and mania using the modules from the DSM-IV. Subsequently, all subjects were asked whether they had had significant (distressing or bothersome) backache, abdominal pain, headaches, or myalgia in the last 7 days. We compared patients meeting the criteria for MDE with individuals without affective symptomatology. Significance of the differences between groups was assessed using the Fisher exact test and multivariate logistic regression analysis. The odds ratios were adjusted for age and sex.
One hundred thirty-two subjects met the criteria for MDE. Forty-eight had non-affective disorders. Seventy-six percent of the subjects meeting the criteria for MDE had at least 1 pain complaint compared to 33% of the control subjects (p < .0001). Fifty percent of the subjects in the midst of a MDE had at least 2 pain complaints compared to 6% of the control subjects (p < .0001). Twenty-nine percent of the subjects in the midst of a MDE had at least 3 pain complaints compared to 2% of the control subjects (p < .0001). Fourteen percent of the subjects in the midst of a MDE had all 4 pain complaints compared to none of the control subjects (p = .002). The odds ratio of subjects with a MDE having a pain complaint relative to control subjects was 5.8 (p < .0001).
That in excess of three fourths of clinically depressed adolescents had 1 or more pain complaints has important implications for adolescent psychiatry and primary care, as well as somatic medicine.
确定符合重度抑郁发作（MDE）标准的青少年中，与非情感性疾病对照组相比，4种前瞻性确定的疼痛主诉的发生率。
在美国和墨西哥边境（得克萨斯州里奥格兰德城）的一家为贫困人口服务的社区心理健康诊所，2001年8月至2003年11月期间连续到该诊所就诊的青少年（年龄范围12 - 17岁），使用《精神疾病诊断与统计手册》第四版（DSM-IV）的模块接受抑郁症和躁狂症的结构化精神科诊断筛查。随后，询问所有受试者在过去7天内是否有严重（令人痛苦或烦恼）的背痛、腹痛、头痛或肌痛。我们将符合MDE标准的患者与无情感症状的个体进行比较。使用Fisher精确检验和多因素逻辑回归分析评估组间差异的显著性。优势比根据年龄和性别进行了调整。
132名受试者符合MDE标准。48名患有非情感性疾病。符合MDE标准的受试者中有76%至少有1种疼痛主诉，而对照组为33%（p <.0001）。处于MDE发作期的受试者中有50%至少有2种疼痛主诉，而对照组为6%（p <.0001）。处于MDE发作期的受试者中有29%至少有3种疼痛主诉，而对照组为2%（p <.0001）。处于MDE发作期的受试者中有14%有全部4种疼痛主诉，而对照组无一例有（p =.002）。患有MDE的受试者出现疼痛主诉的优势比相对于对照组为5.8（p <.0001）。
超过四分之三的临床抑郁症青少年有1种或更多疼痛主诉，这对青少年精神病学、初级保健以及躯体医学都具有重要意义。
