Løyland Borghild
Oslo and Akershus University College of Applied Science, Institute of Nursing and Health Promotion, Oslo, Norway.
Scand J Pain. 2016 Apr;11:65-72. doi: 10.1016/j.sjpain.2015.12.003. Epub 2016 Jan 5.
While lower socioeconomic status increases individual's risk for chronic conditions, little is known about how long-term social assistance recipients (LTRs) with multiple chronic health problems experience chronic pain and/or psychological distress. Social assistance is the last safety net in the Norwegian welfare system and individuals have a legal right to economic assistance if they are unable to support themselves or are entitled to other types of benefits. The purposes of this study were to determine the co-occurrence of both chronic pain and psychological distress and to evaluate for differences in demographic and social characteristics, as well as health-related quality of life, among LTRs.
This descriptive, cross-sectional study surveyed people receiving long-term social assistance in Norway about their health and social functioning from January-November 2005. The social welfare authority offices in each of 14 municipalities in Norway were responsible to locate the LTRs who met the study's inclusion criteria. The selected municipalities provided geographic variability including both rural and urban municipalities in different parts of the country. LTRs were included in this study if they: had received social assistance as their main source of income for at least 6 of the last 12 months; were between 18 and 60 years of age; and were able to complete the study questionnaire. In this study, 405 LTRs were divided into four groups based on the presence or absence of chronic pain and/or psychological distress. (1) Neither chronic pain nor psychological distress (32%, n=119), (2) only chronic pain (12%, n=44), (3) only psychological distress and (24%, n=87), (4) both chronic pain and psychological distress (32%, n=119).
Except for age and marital status, no differences were found between groups in demographic characteristics. Significant differences were found among the four groups on all of the items related to childhood difficulties before the age of 16, except the item on sexual abuse. LTRs with both chronic pain and psychological distress were more likely to have experienced economic problems in their childhood home; other types of abuse than sexual abuse; long-term bullying; and had more often dropped out of school than LTRs with neither chronic pain nor psychological distress. LTRs with both chronic pain and psychological distress, reported more alcohol and substance use/illicit drug use, more feelings of loneliness and a lower mental score on SF-12 than LTRs with only chronic pain.
Co-occurrence of chronic pain and psychological distress is common in LTRs and problems in early life are associated with the co-occurrence of chronic pain and psychological distress in adult life. Although this study cannot assign a clear direction or causality to the association between social and demographic characteristics and chronic pain and psychological distress, the findings when examining LTRs' problems in childhood before the age of 16, indicated that incidents in early life create a probability of chronic pain and psychological distress in the adult life of the individuals. Further studies should use life course studies and longitudinal data in to investigate these important questions in LTRs.
虽然社会经济地位较低会增加个体患慢性病的风险，但对于患有多种慢性健康问题的长期社会救助接受者（LTRs）如何经历慢性疼痛和/或心理困扰，我们知之甚少。社会救助是挪威福利体系中的最后一道安全网，如果个人无法自给自足或有权获得其他类型的福利，他们有获得经济援助的合法权利。本研究的目的是确定慢性疼痛和心理困扰的同时出现情况，并评估LTRs在人口统计学和社会特征以及与健康相关的生活质量方面的差异。
这项描述性横断面研究于2005年1月至11月对挪威接受长期社会救助的人群进行了健康和社会功能调查。挪威14个市镇的社会福利机构负责找出符合研究纳入标准的LTRs。所选市镇提供了地理多样性，包括该国不同地区的农村和城市市镇。如果LTRs符合以下条件，则纳入本研究：在过去12个月中至少有6个月将社会救助作为主要收入来源；年龄在18至60岁之间；能够完成研究问卷。在本研究中，405名LTRs根据是否存在慢性疼痛和/或心理困扰分为四组。（1）既无慢性疼痛也无心理困扰（32%，n = 119），（2）仅慢性疼痛（12%，n = 44），（3）仅心理困扰（24%，n = 87），（4）慢性疼痛和心理困扰都有（32%，n = 119）。
除年龄和婚姻状况外，各群体在人口统计学特征上没有差异。在与16岁之前童年困难相关的所有项目上，四组之间均存在显著差异，但性虐待项目除外。同时患有慢性疼痛和心理困扰的LTRs在童年家庭中更有可能经历经济问题；遭受除性虐待之外的其他类型虐待；长期受欺凌；并且比既无慢性疼痛也无心理困扰的LTRs更常辍学。与仅患有慢性疼痛的LTRs相比，同时患有慢性疼痛和心理困扰的LTRs报告有更多的酒精和物质使用/非法药物使用、更多的孤独感以及SF - 12心理得分更低。
慢性疼痛和心理困扰在LTRs中同时出现很常见，早年的问题与成年后慢性疼痛和心理困扰的同时出现有关。尽管本研究无法明确社会和人口统计学特征与慢性疼痛和心理困扰之间关联的方向或因果关系，但在研究LTRs 16岁之前童年问题时的发现表明，早年的事件会增加个体成年后出现慢性疼痛和心理困扰的可能性。进一步的研究应采用生命历程研究和纵向数据来调查LTRs中的这些重要问题。
