Vun Everett, Turner Sarah, Sareen Jitender, Mota Natalie, Afifi Tracie O, El-Gabalawy Renée
Max Rady College of Medicine, University of Manitoba (Vun); Departments of Community Health Sciences (Turner, Afifi), Psychiatry (Sareen, Afifi, Mota, El-Gabalawy), Clinical Health Psychology (Mota, El-Gabalawy), Anesthesiology, Perioperative and Pain Medicine (El-Gabalawy), Max Rady College of Medicine, University of Manitoba, Winnipeg, Man.
CMAJ Open. 2018 Nov 2;6(4):E528-E536. doi: 10.9778/cmajo.20180093. Print 2018 Oct-Dec.
Chronic pain conditions and mental disorders have high prevalence rates in military populations. However, few investigations have examined the comorbidity between chronic pain conditions and specific mental disorders among Canadian active military personnel.
We conducted a secondary analysis of data from the 2013 Canadian Forces Mental Health Survey (CFMHS) concerning the population of regular members. Diagnostic interviews assessed the presence of mental disorders, and participants self-reported chronic pain conditions (i.e., arthritis, back problems, musculoskeletal conditions, migraines) and indicators of pain severity. We used multiple logistic regressions to assess associations between chronic pain conditions and mental disorders. We used cross-tabulations to assess the prevalence of pain severity indicators in comorbid relationships compared with the chronic pain condition alone. We used moderation analyses to examine the interactions between pain condition by pain severity, and pain condition by activity limitation, respectively, on mental disorders.
The CFMHS included data from 6696 regular members and had a response rate of 79.8%. About one-quarter ( = 1761) of military personnel reported having chronic pain. In the fully adjusted model, all assessed pain conditions were significantly associated with posttraumatic stress disorder (PTSD) (odds ratio [OR] range 1.86-2.55), and several pain conditions were associated with major depressive episode, generalized anxiety disorder and panic disorder. Back problems were significantly associated with all mental disorders apart from alcohol use disorders (OR range 1.40-2.17). Cross-tabulations showed higher prevalence estimates of endorsement for pain severity indicators among pain conditions and comorbid mental disorders, compared with pain conditions alone. Formal moderation analyses showed a significant relationship between migraine and activity limitation on PTSD.
Chronic pain conditions are prevalent and co-occur with mental disorders among Canadian regular force members. Greater understanding of these chronic pain conditions and mental disorders and their impact on people's abilities to adapt to both military and civilian life is needed.
慢性疼痛疾病和精神障碍在军人中患病率很高。然而，很少有调查研究加拿大现役军人中慢性疼痛疾病与特定精神障碍之间的共病情况。
我们对2013年加拿大军队心理健康调查（CFMHS）中关于正规军成员的数据进行了二次分析。诊断访谈评估精神障碍的存在情况，参与者自我报告慢性疼痛疾病（即关节炎、背部问题、肌肉骨骼疾病、偏头痛）以及疼痛严重程度指标。我们使用多元逻辑回归来评估慢性疼痛疾病与精神障碍之间的关联。我们使用交叉表来评估与单独的慢性疼痛疾病相比，共病关系中疼痛严重程度指标的患病率。我们使用调节分析分别检验疼痛严重程度与疼痛疾病之间以及活动受限与疼痛疾病之间对精神障碍的相互作用。
CFMHS包含来自6696名正规军成员的数据，回复率为79.8%。约四分之一（n = 1761）的军人报告患有慢性疼痛。在完全调整模型中，所有评估的疼痛疾病均与创伤后应激障碍（PTSD）显著相关（优势比[OR]范围为1.86 - 2.55），并且几种疼痛疾病与重度抑郁发作、广泛性焦虑障碍和惊恐障碍相关。背部问题与除酒精使用障碍外的所有精神障碍均显著相关（OR范围为1.40 - 2.17）。交叉表显示，与单独的疼痛疾病相比，疼痛疾病和共病精神障碍中疼痛严重程度指标的认可患病率估计更高。正式的调节分析显示偏头痛和活动受限与PTSD之间存在显著关系。
慢性疼痛疾病在加拿大正规部队成员中很普遍，且与精神障碍共病。需要更深入地了解这些慢性疼痛疾病和精神障碍及其对人们适应军事和 civilian 生活能力的影响。 （注：原文中“civilian”未翻译完整，推测可能是“平民”之意，可根据实际情况调整）
