Gerrits Marloes M J G, van Oppen Patricia, van Marwijk Harm W J, Penninx Brenda W J H, van der Horst Henriëtte E
Department of Psychiatry, EMGO Institute for Health and Care Research, VU University Medical Center and Academic Outpatient Clinic for Affective Disorders, GGZ inGeest, Amsterdam, The Netherlands Department of General Practice and Elderly Care Medicine, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands Department of Psychiatry, Leiden University Medical Center, The Netherlands Department of Psychiatry, University Medical Center Groningen, The Netherlands.
Pain. 2014 Jan;155(1):53-59. doi: 10.1016/j.pain.2013.09.005. Epub 2013 Sep 6.
Patients with pain may be at increased risk of developing a first episode of depressive or anxiety disorder. Insight into possible associations between specific pain characteristics and such a development could help clinicians to improve prevention and treatment strategies. The objectives of this study were to examine the impact of pain symptomatology on depression and anxiety onset and to determine whether these associations are independent of subthreshold depressive and anxiety symptoms. Data from the Netherlands Study of Depression and Anxiety, collected between 2004 and 2011, were used. A total of 614 participants with no previous history and no current depression or anxiety at baseline were followed up for 4 years. Onset of depressive or anxiety disorder was assessed at 2- and 4-year follow-up by Composite International Diagnostic Interview. Baseline pain characteristics were location, duration, and severity, as assessed by chronic pain grade. Onset of depressive or anxiety disorder occurred in 15.5% of participants. Using Cox survival analyses, onset of depression and anxiety was associated with 6 pain locations (neck, back, head, orofacial area, abdomen, and joints; hazard ratio [HR]=1.96 to 4.02; P<.05), increasing number of pain locations (HR=1.29; P<.001), and higher severity of pain (HR=1.57; P<.001). By contrast, there was no association with duration of pain symptoms (HR=1.47; P=.12). Independent of subthreshold affective symptoms, only joint pain and increasing number of pain locations were still significantly associated with depression and anxiety onset. Clinicians should be aware that regardless of affective symptoms, pain, particularly at multiple locations, is a risk indicator for developing depressive and anxiety disorders.
疼痛患者首次发生抑郁或焦虑障碍的风险可能会增加。深入了解特定疼痛特征与这种情况发展之间的可能关联，有助于临床医生改进预防和治疗策略。本研究的目的是检验疼痛症状对抑郁和焦虑发作的影响，并确定这些关联是否独立于阈下抑郁和焦虑症状。使用了2004年至2011年期间收集的荷兰抑郁与焦虑研究的数据。共有614名基线时无前科病史且无当前抑郁或焦虑的参与者接受了4年的随访。在2年和4年随访时，通过综合国际诊断访谈评估抑郁或焦虑障碍的发作情况。通过慢性疼痛分级评估的基线疼痛特征包括部位、持续时间和严重程度。15.5%的参与者出现了抑郁或焦虑障碍发作。使用Cox生存分析，抑郁和焦虑发作与6个疼痛部位（颈部、背部、头部、口腔面部区域、腹部和关节；风险比[HR]=1.96至4.02；P<0.05）、疼痛部位数量增加（HR=1.29；P<0.001）以及疼痛严重程度较高（HR=1.57；P<0.001）相关。相比之下，与疼痛症状持续时间无关（HR=1.47；P=0.12）。独立于阈下情感症状，只有关节疼痛和疼痛部位数量增加仍与抑郁和焦虑发作显著相关。临床医生应意识到，无论情感症状如何，疼痛，尤其是多处疼痛，是发生抑郁和焦虑障碍的风险指标。
