Physiotherapy Department,South London and Maudsley NHS Foundation Trust,Denmark Hill, London SE5 8AZ,UK.
KU Leuven,Department of Rehabilitation Sciences,Leuven,Belgium.
Psychol Med. 2017 Dec;47(16):2906-2917. doi: 10.1017/S0033291717001477. Epub 2017 Jun 22.
Depression and pain are leading causes of global disability. However, there is a paucity of multinational population data assessing the association between depression and pain, particularly among low- and middle-income countries (LMICs) where both are common. Therefore, we investigated this association across 47 LMICs.
Community-based data on 273 952 individuals from 47 LMICs were analysed. Multivariable logistic and linear regression analyses were performed to assess the association between the International Classification of Diseases, 10th Revision depression/depression subtypes (over the past 12 months) and pain in the previous 30 days based on self-reported data. Country-wide meta-analysis adjusting for age and sex was also conducted.
The prevalence of severe pain was 8.0, 28.2, 20.2, and 34.0% for no depression, subsyndromal depression, brief depressive episode, and depressive episode, respectively. Logistic regression adjusted for socio-demographic variables, anxiety and chronic medical conditions (arthritis, diabetes, angina, asthma) demonstrated that compared with no depression, subsyndromal depression, brief depressive episode, and depressive episode were associated with a 2.16 [95% confidence interval (CI) 1.83-2.55], 1.45 (95% CI 1.22-1.73), and 2.11 (95% CI 1.87-2.39) increase in odds of severe pain, respectively. Similar results were obtained when a continuous pain scale was used as the outcome. Depression was significantly associated with severe pain in 44/47 countries with a pooled odds ratio of 3.93 (95% CI 3.54-4.37).
Depression and severe pain are highly comorbid across LMICs, independent of anxiety and chronic medical conditions. Whether depression treatment or pain management in patients with comorbid pain and depression leads to better clinical outcome is an area for future research.
抑郁和疼痛是全球残疾的主要原因。然而，在普遍存在这两种疾病的低收入和中等收入国家（LMICs），缺乏评估抑郁和疼痛之间关联的跨国人群数据。因此，我们在 47 个 LMIC 中调查了这种关联。
对来自 47 个 LMIC 的 273952 名个体的基于社区的数据进行了分析。基于自我报告的数据，采用多变量逻辑回归和线性回归分析评估了国际疾病分类第 10 版抑郁/抑郁亚型（过去 12 个月）与过去 30 天内疼痛之间的关联。还进行了全国范围内的荟萃分析，以调整年龄和性别。
无抑郁、亚综合征性抑郁、短暂抑郁发作和抑郁发作的严重疼痛患病率分别为 8.0%、28.2%、20.2%和 34.0%。调整社会人口统计学变量、焦虑和慢性疾病（关节炎、糖尿病、心绞痛、哮喘）的逻辑回归显示，与无抑郁相比，亚综合征性抑郁、短暂抑郁发作和抑郁发作与严重疼痛的比值比分别增加了 2.16（95%置信区间 1.83-2.55）、1.45（95%置信区间 1.22-1.73）和 2.11（95%置信区间 1.87-2.39）。当使用连续疼痛量表作为结果时，也得到了类似的结果。在 47 个国家中的 44 个国家中，抑郁与严重疼痛显著相关，合并比值比为 3.93（95%置信区间 3.54-4.37）。
抑郁和严重疼痛在 LMICs 中高度共病，与焦虑和慢性疾病无关。在伴有疼痛和抑郁共病的患者中，是进行抑郁治疗还是疼痛管理会带来更好的临床结局，这是一个未来的研究领域。
