Campbell Paul, Hope Kate, Dunn Kate M
Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences.
Keele Medical School, Keele University, Keele, Staffordshire, UK.
J Pain Res. 2017 Sep 29;10:2331-2339. doi: 10.2147/JPR.S139445. eCollection 2017.
Low back pain (LBP) is common, impacts on the individual and society, and is a major health concern. Psychological consequences of LBP, such as depression, are significant barriers to recovery, but mechanisms for the development of depression are less well understood. One potential mechanism is the individual's health locus of control (HLoC), that is, perception of the level of control an individual has over their health. The objective of this study is to investigate the moderation effect of HLoC on the pain-depression-disability pathway in those with LBP. The design is a nested cross-sectional analysis of two existing cohorts of patients (n=637) who had previously consulted their primary care physician about LBP. Measures were taken of HLoC, pain intensity and interference, depression, disability, and bothersomeness. Structural Equation Modeling analysis was applied to two path models that examined the pain to depression to disability pathway moderated by the HLoC constructs of Internality and Externality, respectively. Critical ratio (CR) difference tests were applied to the coefficients using pairwise comparisons. The results show that both models had an acceptable model fit and pathways were significant. CR tests indicated a significant moderation effect, with stronger pathway coefficients for depression for those who report low Internality (β 0.48), compared to those with high Internality (β 0.28). No moderation effects were found within the Externality model. HLoC Internality significantly moderates the pain-depression pathway in those with LBP, meaning that those who have a low perception of control report greater levels of depression. HLoC may signify depression among people with LBP, and could potentially be a target for intervention.
腰痛（LBP）很常见，会对个人和社会产生影响，是一个重大的健康问题。腰痛的心理后果，如抑郁，是康复的重大障碍，但抑郁发生的机制尚不太清楚。一个潜在的机制是个体的健康控制点（HLoC），即个体对自身健康控制水平的认知。本研究的目的是调查HLoC对腰痛患者疼痛-抑郁-残疾路径的调节作用。该设计是对两个现有患者队列（n = 637）进行的嵌套横断面分析，这些患者之前曾就腰痛咨询过他们的初级保健医生。测量了HLoC、疼痛强度和干扰、抑郁、残疾和困扰程度。结构方程模型分析应用于两个路径模型，分别检验由内控性和外控性的HLoC结构调节的疼痛-抑郁-残疾路径。使用成对比较对系数进行临界比（CR）差异检验。结果表明，两个模型都具有可接受的模型拟合度，路径显著。CR检验表明存在显著的调节作用，与内控性高的人（β 0.28）相比，报告内控性低的人抑郁的路径系数更强（β 0.48）。在外控性模型中未发现调节作用。HLoC内控性显著调节腰痛患者的疼痛-抑郁路径，这意味着对控制感低的人报告的抑郁水平更高。HLoC可能预示着腰痛患者的抑郁情况，并且可能成为干预的目标。
