Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzer Str. 46, 01187, Dresden, Germany.
Soc Psychiatry Psychiatr Epidemiol. 2010 Jan;45(1):89-104. doi: 10.1007/s00127-009-0045-1. Epub 2009 Apr 10.
To examine in a nationally representative sample (a) the differential association of specific anxiety and depressive disorders defined according to DSM-IV with pain disorder (PD) and pain symptoms, and (b) whether pain-associated anxiety and depressive disorders and their comorbidity have different implications in terms of impairment, disability, health care utilization, and substance use.
A nationally representative community study was conducted in Germany. Symptoms, syndromes and diagnoses of mental disorders, and pain were assessed in N = 4,181 participants aged 18-65 years using the DSM-IV/M-CIDI.
Logistic regressions revealed that pain is associated with both specific anxiety and depressive disorders, with increasing significant odds ratios (OR) for medically explained pain symptoms (EPS; OR range: 1.9-2.0), to unexplained pain symptoms (UPS; OR range: 2.4-7.3), to PD (OR range: 3.3-14.8). PD and UPS persistently showed associations after adjusting for comorbid other anxiety and depressive disorders and physical illnesses. All types of pain, particularly PD/UPS, are associated with decreased quality of life, greater impairment in role functioning, disability, health care utilization, and substance use. Depressive disorders, even more so anxiety disorders and their comorbidity account for a substantial proportion of variance in these functional correlates.
Pain is strongly associated with specific anxiety and depressive disorders. In light of the individual and societal burden due to pain, and the demonstrated role of comorbid anxiety or/and depression, our results call for further investigation of the underlying mechanisms for this association as well as targeted treatments for these comorbidities.
在全国代表性样本中考察（a）根据 DSM-IV 定义的特定焦虑和抑郁障碍与疼痛障碍（PD）和疼痛症状的差异关联，以及（b）与疼痛相关的焦虑和抑郁障碍及其共病在功能障碍、残疾、医疗保健利用和物质使用方面是否具有不同的意义。
在德国进行了一项全国性的社区研究。使用 DSM-IV/M-CIDI 评估了年龄在 18-65 岁之间的 4181 名参与者的精神障碍症状、综合征和诊断以及疼痛。
逻辑回归显示，疼痛与特定的焦虑和抑郁障碍均相关，具有更高的医疗解释性疼痛症状（EPS；OR 范围：1.9-2.0）、未解释的疼痛症状（UPS；OR 范围：2.4-7.3）、PD（OR 范围：3.3-14.8）的显著优势比（OR）。在调整了共病其他焦虑和抑郁障碍以及身体疾病后，PD 和 UPS 仍然存在关联。所有类型的疼痛，尤其是 PD/UPS，都与生活质量下降、角色功能障碍、残疾、医疗保健利用和物质使用增加有关。抑郁障碍，甚至焦虑障碍及其共病，在这些功能相关因素的变异性中占很大比例。
疼痛与特定的焦虑和抑郁障碍密切相关。鉴于疼痛给个人和社会带来的负担，以及共病焦虑或/和抑郁所表现出的作用，我们的研究结果呼吁进一步研究这种关联的潜在机制，以及针对这些共病的靶向治疗。
