Bauer H, Emeny R T, Baumert J, Ladwig K-H
Institute of Epidemiology II, Helmholtz Zentrum München, Neuherberg, Germany.
Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Klinikum der Universität München, Munich, Germany.
Eur J Pain. 2016 Sep;20(8):1253-65. doi: 10.1002/ejp.850. Epub 2016 Feb 23.
Chronic pain is frequent in elderly people and, especially if widespread, associated with poor mental health. We investigated whether a resilient personality protects older adults against the adverse effects of chronic pain.
Pain status [no pain, chronic local pain (CLP) and chronic widespread pain (CWP)] was determined using the American College of Rheumatologists' criteria for widespread pain in a cross-sectional sample of 724 participants aged 68-92 years drawn from the population-based KORA-Age study in Southern Germany. Depressive symptoms and resilience were assessed via the scales GDS-15 and RS-5. The relation between pain, resilience and depressive symptoms was modelled using logistic and quantile regression.
CLP prevalence and CWP prevalence were 57.5% and 12.3%, respectively. Confounder-adjusted logistic regression indicated a fourfold risk of depressed mood (GDS-15 ≥ 5) in CWP, vs. no pain (OR = 4.08, 95% CI 1.90-8.74). However, in quantile regression, the adverse effect of CWP was significantly attenuated by resilience when looking at the GDS-15 score lower quartile (p = 0.011) and median (p = 0.011). This effect appeared to be mainly driven by participants aged 75-84 years. Confounder adjustment reduced the effect of CLP on depressive symptoms to non-significance, and effect modification by resilience was undetectable in regression models of CLP.
Resilience was protective in the association of CWP with depressive symptoms in this analysis. Older adults with CWP may potentially benefit from interventions supporting resilience. Prospective research should investigate the protective role of resilience in the potentially self-perpetuating relation between chronic pain and depressed affect. WHAT DOES THIS STUDY ADD?: The association of chronic widespread pain with depressive symptoms in the elderly population is attenuated by resilience.
慢性疼痛在老年人中很常见，尤其是疼痛范围广泛时，会与心理健康状况不佳相关。我们研究了坚韧的性格是否能保护老年人免受慢性疼痛的不利影响。
在德国南部基于人群的KORA-Age研究中选取了724名年龄在68至92岁的参与者作为横断面样本，使用美国风湿病学会的广泛性疼痛标准确定疼痛状况[无疼痛、慢性局部疼痛（CLP）和慢性广泛性疼痛（CWP）]。通过GDS-15和RS-5量表评估抑郁症状和心理韧性。使用逻辑回归和分位数回归对疼痛、心理韧性和抑郁症状之间的关系进行建模。
CLP患病率和CWP患病率分别为57.5%和12.3%。经混杂因素调整的逻辑回归表明，与无疼痛相比，CWP患者出现抑郁情绪（GDS-15≥5）的风险高出四倍（OR = 4.08，95%CI 1.90 - 8.74）。然而，在分位数回归中，当观察GDS-15评分的下四分位数（p = 0.011）和中位数（p = 0.011）时，心理韧性显著减弱了CWP的不利影响。这种效应似乎主要由75至84岁的参与者驱动。混杂因素调整使CLP对抑郁症状的影响降至无统计学意义，并且在CLP的回归模型中未检测到心理韧性的效应修正。
在本分析中，心理韧性在CWP与抑郁症状的关联中具有保护作用。患有CWP的老年人可能会从支持心理韧性的干预措施中获益。前瞻性研究应调查心理韧性在慢性疼痛与抑郁情绪之间潜在的自我延续关系中的保护作用。本研究补充了什么？：心理韧性减弱了老年人群中慢性广泛性疼痛与抑郁症状之间的关联。
