Department of Psychiatry, Virginia Commonwealth University, Richmond, VA 23298, USA.
Psychosomatics. 2011 May-Jun;52(3):272-9. doi: 10.1016/j.psym.2011.01.010.
Somatic symptoms have been extensively studied in primary care, but infrequently in diseases causing pain in multiple sites. We therefore examined the impact of somatic symptom burden (SSB) on pain, depression, anxiety, health-care utilization, and quality-of-life in adults with sickle cell disease (SCD).
Subjects were 230 adults in the prospective Pain in Sickle Cell Epidemiology Study (PiSCES). Baseline data included demographics, genotype, Patient Health Questionnaire (PHQ), and SF-36 health-related quality of life (HRQOL). In daily diaries for 6 months, patients recorded SCD pain and SCD health-care utilization. To exclude common SCD pain sites, we abridged the PHQ's 15 somatic symptoms to 11 (PHQscd). We divided subjects into two groups: PHQscd≥11 (high SSB), and PHQscd<11 (low SSB).
High SSB occurred in 18.3% of subjects and was more frequent in women than men (24.6% vs. 9.1%, p=0.0033). Sixty percent of subjects with anxiety and 37.5% of those with depression had comorbid high SSB. Percentage of pain days not in crisis pain was significantly higher in somatizers, but crisis pain did not differ between groups. The high SSB group's hospitalization, scheduled doctor visits, and overall utilization, particularly on non-crisis days were significantly higher than the low SSB group's (p values < 0.05). All SF-36 subscales were significantly negatively correlated with PHQscd (p<0.0001).
Even after excluding common SCD pain complaints, high somatic symptom burden was 1.5 to 2 times more prevalent in SCD patients than in primary care. High SSB in SCD predicts more non-crisis pain and healthcare utilization for pain, and is associated with depression, anxiety, and poorer HRQOL.
躯体症状在初级保健中得到了广泛研究，但在引起多处疼痛的疾病中却很少研究。因此，我们研究了躯体症状负担（SSB）对镰状细胞病（SCD）成人疼痛、抑郁、焦虑、医疗保健利用和生活质量的影响。
本研究纳入了前瞻性镰状细胞病疼痛流行病学研究（PiSCES）中的 230 名成年人。基线数据包括人口统计学、基因型、患者健康问卷（PHQ）和 SF-36 健康相关生活质量（HRQOL）。在 6 个月的日常日记中，患者记录了 SCD 疼痛和 SCD 医疗保健利用情况。为了排除常见的 SCD 疼痛部位，我们将 PHQ 的 15 种躯体症状简化为 11 种（PHQscd）。我们将受试者分为两组：PHQscd≥11（高 SSB）和 PHQscd<11（低 SSB）。
高 SSB 发生率为 18.3%，女性高于男性（24.6% vs. 9.1%，p=0.0033）。60%的焦虑症患者和 37.5%的抑郁症患者同时存在高 SSB。躯体症状患者的无危机疼痛天数比例明显较高，但两组间的危机疼痛无差异。高 SSB 组的住院、预约医生就诊和整体就诊次数，尤其是非危机就诊次数明显高于低 SSB 组（p 值<0.05）。所有 SF-36 子量表均与 PHQscd 呈显著负相关（p<0.0001）。
即使排除了常见的 SCD 疼痛症状，高躯体症状负担在 SCD 患者中的发生率仍比初级保健中高 1.5 至 2 倍。SCD 患者的高 SSB 预示着更多的非危机疼痛和疼痛相关的医疗保健利用，并且与抑郁、焦虑和较差的 HRQOL 相关。
