Health Psychology Programs, California School of Professional Psychology, 6212 Ferris Square, 92121, San Diego, CA.
Ann Behav Med. 1995 Dec;17(4):349-56. doi: 10.1007/BF02888600.
This research evaluated a model for examining the role of family cohesion and the pain-coping process in predicting depressive symptoms in fibromyalgia, a chronic pain disorder of unknown etiology. Depressive symptoms were highly prevalent in this patient group. Fifty-nine percent of the sample met or exceeded the cutoff score of 16 for depression on the Center for Epidemiological Studies Depression Scale (CES-D), while slightly greater than 50% exceeded the cutoff score of 19, a figure that is suggested for evaluating depression in chronic pain populations. Multiple regression analyses, controlling for demographic factors and medication use, revealed that low family cohesion (either reported by the patient or the patient's spouse), high pain, high helplessness, and high passive coping contributed independently to greater CES-D scores. Pain also was related to higher depression scores indirectly through its association with greater helplessness and passive coping. In contrast, no indirect effects of family cohesion were found on depressive symptoms through pain, helplessness, and passive coping. Structural equation modeling procedures provided confirmatory evidence of the significance of these relationships, indicating a high degree of goodness-of-fit with the model examined. The data illustrate the import of a multidimensionalframeworkfor conceptualizing physical, psychological, and social determinants of depressive disturbance in fibromyalgia.
本研究评估了一个模型，用于考察家庭凝聚力和疼痛应对过程在预测纤维肌痛（一种病因不明的慢性疼痛障碍）患者抑郁症状中的作用。在这个患者群体中，抑郁症状非常普遍。59%的样本在流行病学研究中心抑郁量表（CES-D）上的抑郁得分超过 16 分的临界值，而略高于 50%的样本超过了 19 分的临界值，这一数字用于评估慢性疼痛人群中的抑郁。在控制人口统计学因素和药物使用的情况下，多元回归分析显示，家庭凝聚力低（无论是患者还是患者的配偶报告的）、疼痛程度高、无助感高和被动应对方式高都与 CES-D 得分更高有关。疼痛也通过与更大的无助感和被动应对方式相关，间接地与更高的抑郁得分相关。相比之下，在疼痛、无助感和被动应对方式方面，家庭凝聚力对抑郁症状没有间接影响。结构方程建模程序提供了这些关系意义的验证证据，表明所检查的模型具有很高的拟合度。这些数据说明了在纤维肌痛中，从身体、心理和社会等多个维度来概念化抑郁障碍的决定因素的重要性。
