Costa Eleonora C V, Vale Sandrine, Sobral Manuel, Graça Pereira M
a Department of Psychology , Portuguese Catholic University , Praça da Faculdade 1, 4710-297 Braga , Portugal.
b Applied Psychology Department, School of Psychology , University of Minho , Braga , Portugal.
Psychol Health Med. 2016 Jun;21(4):483-495. doi: 10.1080/13548506.2015.1109673. Epub 2015 Nov 11.
Depression and anxiety symptoms in chronic pain are associated with adverse clinical outcomes, and appear highly related to patient's illness perceptions as well as with marital adjustment. This study aimed to investigate the predictive value of pain variables, marital adjustment and illness perceptions on depression and anxiety in patients with chronic pain. Two hundred patients were recruited from a pain unit in a public hospital in the north of Portugal. Patients completed a questionnaire that assessed illness perceptions (IPQ-Brief), marital adjustment (revised dyadic adjustment scale), depression and anxiety symptoms (hospital anxiety depression scale) and pain variables (pain intensity and pain disability index). Depression and anxiety symptoms were associated with pain intensity, pain-related disability, marital adjustment and illness perceptions. Results from hierarchical regression showed that illness perceptions contributed significantly to depression and anxiety symptoms over and above the effects of pain intensity, pain-related disability and marital adjustment, after controlling for gender. In multivariate analyses, pain intensity, pain-related disability and marital adjustment were uniquely related to depression and anxiety symptoms, whereas specific illness perceptions were uniquely related to depression symptoms (identity, treatment control, emotional response and coherence) and to anxiety symptoms (identity, emotional response and concern). Perceptions of greater symptomatology (identity) and of emotional impact, and lesser perceptions of treatment control and understanding of chronic pain (illness comprehensibility) were significantly associated with increased depression symptoms. Perceptions of greater symptomatology (identity), emotional impact and greater concern were associated with anxiety symptoms. These findings indicate that the contribution of illness perceptions was greater than that made by traditional covariates, and may therefore be a useful basis for future psychological interventions.
慢性疼痛中的抑郁和焦虑症状与不良临床结局相关，且似乎与患者的疾病认知以及婚姻适应高度相关。本研究旨在调查疼痛变量、婚姻适应和疾病认知对慢性疼痛患者抑郁和焦虑的预测价值。从葡萄牙北部一家公立医院的疼痛科招募了200名患者。患者完成了一份问卷，该问卷评估了疾病认知（IPQ简表）、婚姻适应（修订的二元适应量表）、抑郁和焦虑症状（医院焦虑抑郁量表）以及疼痛变量（疼痛强度和疼痛残疾指数）。抑郁和焦虑症状与疼痛强度、疼痛相关残疾、婚姻适应和疾病认知相关。分层回归结果显示，在控制性别后，疾病认知对抑郁和焦虑症状的贡献显著超过疼痛强度、疼痛相关残疾和婚姻适应的影响。在多变量分析中，疼痛强度、疼痛相关残疾和婚姻适应与抑郁和焦虑症状有独特关联，而特定的疾病认知与抑郁症状（一致性、治疗控制、情绪反应和连贯性）以及焦虑症状（一致性、情绪反应和担忧）有独特关联。对更多症状（一致性）和情绪影响的认知，以及对治疗控制和慢性疼痛理解（疾病可理解性）的较少认知与抑郁症状增加显著相关。对更多症状（一致性）、情绪影响和更多担忧的认知与焦虑症状相关。这些发现表明，疾病认知的贡献大于传统协变量，因此可能是未来心理干预的有用基础。
