Konietzny Kerstin, Chehadi Omar, Streitlein-Böhme Irmgard, Rusche Herbert, Willburger Roland, Hasenbring Monika Ilona
Department of Medical Psychology and Medical Sociology, Faculty of Medicine, Ruhr-University of Bochum, Universitätsstr. 150, 44801, Bochum, Germany.
Department of General Medicine, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Int J Behav Med. 2018 Apr;25(2):207-214. doi: 10.1007/s12529-017-9657-0.
Mild depression has been shown as a precursor and as a consequence of low back pain, even in early phases of acute or subacute pain. Chronic daily life stress as well as dysfunctional pain-related cognitions such as thought suppression (TS) seem to play a role in the pain-depression cycle; however, the mechanisms of these associations are less understood. Experimentally induced TS, conceived as the attempt to directly suppress sensations such as pain, has been shown to paradoxically cause a delayed and non-volitional return of the suppressed thoughts and sensations and to increase affective distress. These dysfunctional processes are supposed to increase under high cognitive load, such as high stress.
In the present cross-sectional study, we for the first time sought to examine a possible interaction between habitual TS and stress on depression in N = 177 patients with subacute low back pain (SLBP), using the following questionnaires: Subscale Thought Suppression from Avoidance-Endurance Questionnaire, Beck Depression Inventory, and Kiel Interview of Subjective Situation. A three-way ANOVA was conducted with two groups of TS (high/low), stress (high/low) and sex as independent factors and depression as dependent.
Results indicated a significant three-way interaction with highest depression scores in female patients showing high TS and high stress. Overall main effects for sex and stress indicated higher depression in women and in highly stressed patients.
Our findings support the hypothesis that TS heightens depressive mood under conditions of high cognitive load especially in female patients with SLBP indicating a special vulnerability for depressive mood in women with SLBP.
轻度抑郁已被证明是腰痛的先兆和后果，即使在急性或亚急性疼痛的早期阶段也是如此。慢性日常生活压力以及与疼痛相关的功能失调认知，如思维抑制（TS），似乎在疼痛-抑郁循环中起作用；然而，这些关联的机制尚不太清楚。实验诱导的TS，被认为是直接抑制疼痛等感觉的尝试，已被证明会反常地导致被抑制的思维和感觉延迟且非自愿地回归，并增加情感困扰。这些功能失调的过程在高认知负荷（如高压力）下应该会增加。
在本横断面研究中，我们首次试图使用以下问卷，研究习惯性TS与压力对177例亚急性腰痛（SLBP）患者抑郁的可能相互作用：回避-耐力问卷中的思维抑制分量表、贝克抑郁量表和基尔主观情境访谈。以两组TS（高/低）、压力（高/低）和性别作为独立因素，抑郁作为因变量进行三因素方差分析。
结果表明，在高TS和高压力的女性患者中，存在显著的三因素交互作用，抑郁得分最高。性别和压力的总体主效应表明，女性和高压力患者的抑郁程度更高。
我们的研究结果支持以下假设，即TS在高认知负荷条件下会加剧抑郁情绪，尤其是在SLBP女性患者中，这表明SLBP女性在抑郁情绪方面具有特殊的易感性。
