Hung Ching-I, Liu Chia-Yih, Fu Tsai-Sheng
Department of Psychiatry, Chang Gung Memorial Hospital at Linko and Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Orthopedics, Chang Gung Memorial Hospital at Keelung and Chang Gung University College of Medicine, Taoyuan, Taiwan
Int J Psychiatry Med. 2015;49(3):187-98. doi: 10.1177/0091217415573937. Epub 2015 Apr 30.
The study aimed to compare the associations of pain indices, depression, anxiety, and somatic symptoms with disability among outpatients with chronic low back pain (CLBP).
Consecutive orthopedics outpatients with CLBP in a medical center were enrolled. The Oswestry Disability Index and physical functioning and role limitations-physical of the Short-Form 36 were used as disability indices. The Hospital Anxiety and Depression Scale (HADS) and the Depression and Somatic Symptoms Scale were employed. Pain intensity was rated using a visual analogue scale. Multiple linear regressions were used to determine the impacts of these independent factors related to disability.
Among 225 participants (122 male, 103 female) with CLBP, patients with major depressive disorder and associated leg symptoms of CLBP had higher disability indices. A tendency was noted that depression (HADS-depression) had the highest correlation to the three disability indices, followed by pain intensity, anxiety, and somatic symptoms. After controlling for demographic variables, HADS-depression explained the highest variance of disability, followed by pain intensity.
Depression was the most powerful factor associated with disability of CLBP among depression, anxiety, and somatic symptoms. Depression should be evaluated when investigating disability among patients with CLBP.
本研究旨在比较慢性下腰痛（CLBP）门诊患者的疼痛指数、抑郁、焦虑和躯体症状与残疾之间的关联。
纳入一家医疗中心连续就诊的CLBP骨科门诊患者。采用Oswestry残疾指数以及简短健康调查问卷36项中的身体功能和身体角色限制作为残疾指标。使用医院焦虑抑郁量表（HADS）和抑郁与躯体症状量表。采用视觉模拟量表对疼痛强度进行评分。使用多元线性回归来确定这些与残疾相关的独立因素的影响。
在225名CLBP参与者（122名男性，103名女性）中，患有重度抑郁症和CLBP相关腿部症状的患者残疾指数更高。有趋势表明，抑郁（HADS-抑郁）与三个残疾指标的相关性最高，其次是疼痛强度、焦虑和躯体症状。在控制人口统计学变量后，HADS-抑郁对残疾的方差解释最高，其次是疼痛强度。
在抑郁、焦虑和躯体症状中，抑郁是与CLBP残疾相关的最有力因素。在调查CLBP患者的残疾情况时，应评估抑郁情况。
