Nicholl Barbara I, Smith Daniel J, Cullen Breda, Mackay Daniel, Evans Jonathan, Anderson Jana, Lyall Donald M, Fawns-Ritchie Chloe, McIntosh Andrew M, Deary Ian J, Pell Jill P, Mair Frances S
Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK.
Centre for Cognitive Ageing and Cognitive Epidemiology, Department of Psychology, University of Edinburgh, Edinburgh, UK.
BMC Fam Pract. 2015 Oct 6;16:128. doi: 10.1186/s12875-015-0343-5.
Comorbid chronic pain and depression is a challenging dyad of conditions to manage in primary care and reporting has shown to vary by ethnic group. Whether the relationship between depression and chronic pain varies by ethnicity is unclear. This study aims to explore chronic pain and depression reporting across ethnic groups and examine whether this association differs, independently of potential confounding factors.
Cross-sectional study of UK Biobank participants with complete data on chronic pain and probable lifetime history of depression, who reported their ethnic group as White, Asian/Asian British or Black/Black British. Chronic pain classification: present if participants had ≥ 1 site of body pain (up to seven sites or "pain all over the body" could be selected) that lasted ≥ 3 months; extent of chronic pain categories: 0, 1, 2-3, 4-7 sites or pain all over the body. Probable depression classification: an algorithm of low mood, anhedonia and help-seeking behaviour. Relationship between depression and presence/extent of chronic pain assessed using logistic/multinomial regression models (odds ratio (OR); relative risk ratio (RRR), 95 % confidence intervals), adjusted for sociodemographic, lifestyle, and morbidity factors; and a final adjustment for current depressive symptoms.
The number of participants eligible for inclusion was 144,139: 35,703 (94 %) White, 4539 (3 %) Asian, and 3897 (3 %) Black. Chronic pain was less (40.5 %, 45.8 %, 45.0 %, respectively) and depression more (22.1 %, 12.9 %, 13.8 %, respectively) commonly reported in White participants than Asian and Black participants. Statistically significant associations between depression and presence/extent of chronic pain persisted following adjustment for potential confounding variables; this relationship was strongest for Black participants (presence of chronic pain: OR 1.86 (1.52, 2.27); RRR 1 site 1.49 (1.16, 1.91), 2-3 sites 1.98 (1.53, 2.56), 4-7 sites 3.23 (2.09, 4.99), pain all over the body 3.31 (2.05, 5.33). When current depressive symptoms were considered these relationships were attenuated.
Chronic pain and depression reporting varies across ethnic groups. Differences in health seeking behaviour between ethnic groups may impact on the results reported. Clinicians, particularly in primary care, need to be aware of the cultural barriers within certain ethic groups to expressing concern over mood and to consider their approach accordingly.
慢性疼痛与抑郁症并存是初级保健中难以处理的一对病症，且报告显示不同种族群体的情况有所差异。抑郁症与慢性疼痛之间的关系是否因种族而异尚不清楚。本研究旨在探讨不同种族群体中慢性疼痛和抑郁症的报告情况，并检验这种关联是否存在差异，同时排除潜在的混杂因素。
对英国生物银行中具有慢性疼痛完整数据和可能的终生抑郁症病史的参与者进行横断面研究，这些参与者将自己的种族报告为白人、亚裔/亚裔英国人或黑人/黑人英国人。慢性疼痛分类：如果参与者有≥1个身体疼痛部位（最多可选择7个部位或“全身疼痛”）且持续≥3个月，则为存在慢性疼痛；慢性疼痛类别的范围：0、1、2 - 3、4 - 7个部位或全身疼痛。可能的抑郁症分类：基于情绪低落、快感缺失和寻求帮助行为的算法。使用逻辑/多项回归模型（比值比（OR）；相对风险比（RRR），95%置信区间）评估抑郁症与慢性疼痛的存在/程度之间的关系，并对社会人口统计学、生活方式和发病因素进行调整；最后对当前抑郁症状进行调整。
符合纳入标准的参与者有144,139人：35,703人（94%）为白人，4539人（3%）为亚裔，3897人（3%）为黑人。与亚裔和黑人参与者相比，白人参与者报告的慢性疼痛较少（分别为40.5%、45.8%、45.0%），而抑郁症较多（分别为22.1%、12.9%、13.8%）。在对潜在混杂变量进行调整后，抑郁症与慢性疼痛的存在/程度之间的统计学显著关联仍然存在；这种关系在黑人参与者中最为强烈（存在慢性疼痛：OR 1.86（1.52，2.27）；RRR 1个部位1.49（1.16，1.91），2 - 3个部位1.98（1.53，2.56），4 - 7个部位3.23（2.09，4.99），全身疼痛3.31（2.05，5.33））。当考虑当前抑郁症状时，这些关系减弱。
不同种族群体中慢性疼痛和抑郁症的报告情况有所不同。种族群体之间在寻求医疗行为上的差异可能会影响报告结果。临床医生，尤其是初级保健医生，需要意识到某些种族群体在表达情绪方面存在的文化障碍，并相应地考虑他们的诊疗方法。
