Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, USA.
Eur J Pain. 2013 Aug;17(7):1058-67. doi: 10.1002/j.1532-2149.2012.00272.x. Epub 2012 Dec 28.
Elevated depressive symptoms are common in youth with chronic pain, and pain symptoms are frequent in adolescents with depressive disorders. While studies have identified concurrent associations between pain and depression over time in youth, it is unclear how change in one symptom impacts change in the other symptom.
This three-time point 12-month longitudinal study examined reciprocal associations among pain and depression in a clinical sample of adolescents (12-18) diagnosed with chronic pain (n = 55) or a depressive disorder (n = 40). Mixed-effects multivariate models were used to test if changes over a preceding time interval predicted symptom severity at subsequent time points. Study group, age, sex, race, baseline pain intensity and baseline depressive symptoms were included as covariates.
Generalized estimating equations revealed that pain and depressive symptoms were significantly associated over time (β = 1.54; p < 0.001). As hypothesized, changes in pain were associated with subsequent depressive symptoms (β = 1.16; p < 0.001). Conversely, changes in depressive symptoms predicted subsequent pain (β = 0.026; p < 0.05), but with a weaker association. In the model predicting pain, an interaction between depressive symptoms and study group emerged (β = -0.02; p < 0.05), with change in depressive symptoms having the greatest impact on pain in the depressed sample.
Findings extend previous adult research to an adolescent sample showing changes in pain intensity are predictive of subsequent depressive symptoms. In comparison to adult data, changes in depressive symptoms had less impact on subsequent pain in youth. Future research can examine how targeting persistent pain may also aid the treatment of depressive symptoms in adolescents.
患有慢性疼痛的年轻人中常见抑郁症状升高，而患有抑郁障碍的青少年中疼痛症状也很常见。虽然研究已经确定了青少年时期疼痛和抑郁症状随时间的同时关联，但尚不清楚一种症状的变化如何影响另一种症状的变化。
这项三时间点、为期 12 个月的纵向研究，在患有慢性疼痛（n=55）或抑郁障碍（n=40）的青少年临床样本中，研究了疼痛和抑郁之间的相互关联。使用混合效应多元模型来检验前一时间间隔的变化是否预测后续时间点的症状严重程度。研究组、年龄、性别、种族、基线疼痛强度和基线抑郁症状被纳入协变量。
广义估计方程显示，疼痛和抑郁症状随时间显著相关（β=1.54；p<0.001）。正如假设的那样，疼痛的变化与随后的抑郁症状相关（β=1.16；p<0.001）。相反，抑郁症状的变化预测了随后的疼痛（β=0.026；p<0.05），但关联较弱。在预测疼痛的模型中，抑郁症状和研究组之间出现了一个交互作用（β=-0.02；p<0.05），抑郁症状的变化对抑郁组的疼痛影响最大。
研究结果将先前的成人研究扩展到青少年样本，表明疼痛强度的变化可预测随后的抑郁症状。与成人数据相比，青少年时期抑郁症状的变化对随后的疼痛影响较小。未来的研究可以检验靶向持续疼痛是否也有助于青少年抑郁症状的治疗。
