Gerrits Marloes M J G, van Oppen Patricia, Leone Stephanie S, van Marwijk Harm W J, van der Horst Henriëtte E, Penninx Brenda W
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.
BMC Psychiatry. 2014 Jun 25;14:187. doi: 10.1186/1471-244X-14-187.
Studies suggest that poor physical health might be associated with increased depression and anxiety recurrence. The objectives of this study were to determine whether specific chronic diseases and pain characteristics are associated with depression and anxiety recurrence and to examine whether such associations are mediated by subthreshold depressive or anxiety symptoms.
1122 individuals with remitted depressive or anxiety disorder (Netherlands Study of Depression and Anxiety) were followed up for a period of four years. The impact of specific chronic diseases and pain characteristics on recurrence was assessed using Cox regression and mediation analyses.
Chronic diseases were not associated with recurrence. Neck (HR 1.45, p < .01), chest (HR 1.65, p < .01), abdominal (HR 1.52, p < .01) pain, an increase in the number of pain locations (HR 1.10, p < .01) and pain severity (HR 1.18, p = .01) were associated with an increased risk of depression recurrence but not anxiety. Subthreshold depressive symptoms mediated the associations between pain and depression recurrence.
Pain, not chronic disease, increases the likelihood of depression recurrence, largely through its association with aggravated subthreshold depressive symptoms. These findings support the idea of the existence of a mutually reinforcing mechanism between pain and depression and are indicative of the importance of shedding light on neurobiological links in order to optimize pain and depression management.
研究表明，身体健康状况不佳可能与抑郁和焦虑复发风险增加有关。本研究的目的是确定特定的慢性疾病和疼痛特征是否与抑郁和焦虑复发相关，并检验这种关联是否由阈下抑郁或焦虑症状介导。
对1122例缓解期抑郁或焦虑障碍患者（荷兰抑郁与焦虑研究）进行了为期四年的随访。使用Cox回归和中介分析评估特定慢性疾病和疼痛特征对复发的影响。
慢性疾病与复发无关。颈部疼痛（风险比[HR] 1.45，p < .01）、胸部疼痛（HR 1.65，p < .01）、腹部疼痛（HR 1.52，p < .01）、疼痛部位数量增加（HR 1.10，p < .01）和疼痛严重程度增加（HR 1.18，p = .01）与抑郁复发风险增加相关，但与焦虑复发无关。阈下抑郁症状介导了疼痛与抑郁复发之间的关联。
疼痛而非慢性疾病增加了抑郁复发的可能性，这主要是通过其与加重的阈下抑郁症状的关联实现的。这些发现支持了疼痛与抑郁之间存在相互强化机制的观点，并表明阐明神经生物学联系对于优化疼痛和抑郁管理的重要性。
