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社会支持和抑郁症状对老年多病患者疼痛的调节作用——来自多中心、前瞻性、观察性队列研究MultiCare的数据

The moderating effects of social support and depressive symptoms on pain among elderly multimorbid patients-data from the multicentre, prospective, observational cohort study MultiCare.

作者信息

Mallon Tina, Schäfer Ingmar, Fuchs Angela, Gensichen Jochen, Maier Wolfgang, Riedel-Heller Steffi, König Hans-Helmut, Mergenthal Karola, Schön Gerhard, Wegscheider Karl, Weyerer Siegfried, Wiese Birgitt, van den Bussche Hendrik, Scherer Martin

机构信息

Department of Primary Medical Care, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.

Institute of General Practice, University Düsseldorf, Düsseldorf, Germany.

出版信息

Aging Ment Health. 2022 Apr;26(4):803-809. doi: 10.1080/13607863.2021.1916882. Epub 2021 May 5.

Abstract

OBJECTIVES

Depressive symptoms and chronic pain are common among patients with multimorbidity creating a complex medical condition for both the patient and the general practitioner. Perceived social support may function as a protective measure.

UNLABELLED

To examine the impact of perceived social support as a potential moderator between depressive symptoms and pain intensity and pain disability in daily activities in multimorbid patients aged 75+.

METHOD

Data from 3,189 patients of the German longitudinal cohort study MultiCare were obtained at baseline and follow-ups during 5 years. Multilevel linear mixed-effects analyses were conducted for pain intensity (model 1) and pain disability in daily activities (model 2). The interaction term social support by depression score was included to test for moderation.

RESULTS

The interaction between social support and depressive symptoms was significantly associated with the pain intensity score 0.41 (SE=.17; 95-CI[.08;.74]) but not with the pain disability score 0.35 (SE=.19; 95-CI[-.01;.72]). Additionally, men and individuals with medium or higher educational level showed reduced pain intensity and disability scores. Pain disability scores increased with age and depressive symptoms. Increased pain scores were also found for body mass index and burden of multimorbidity.

CONCLUSION

Perceived social support amplified the association of depressive symptoms on pain intensity and did not show a protective function. The high scores of perceived social support among the participants may point to the practice of secondary gain due to the patients immense health burden.

摘要

目的

抑郁症状和慢性疼痛在患有多种疾病的患者中很常见,这给患者和全科医生都带来了复杂的医疗状况。感知到的社会支持可能起到保护作用。

未标注

研究感知到的社会支持作为75岁以上患有多种疾病患者抑郁症状与疼痛强度及日常活动中疼痛残疾之间潜在调节因素的影响。

方法

从德国纵向队列研究MultiCare的3189名患者在基线和5年随访期间获取数据。对疼痛强度(模型1)和日常活动中的疼痛残疾(模型2)进行多水平线性混合效应分析。纳入社会支持与抑郁评分的交互项以检验调节作用。

结果

社会支持与抑郁症状之间的交互作用与疼痛强度评分显著相关,系数为0.41(标准误=0.17;95%置信区间[0.08;0.74]),但与疼痛残疾评分无关,系数为0.35(标准误=0.19;95%置信区间[-0.01;0.72])。此外,男性以及中等或更高教育水平的个体疼痛强度和残疾评分较低。疼痛残疾评分随年龄和抑郁症状增加。体重指数和多种疾病负担增加也会导致疼痛评分升高。

结论

感知到的社会支持增强了抑郁症状与疼痛强度之间的关联,并未显示出保护作用。参与者中感知到的社会支持高分可能表明由于患者巨大的健康负担而存在继发获益行为。

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