Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC), Durham Veterans Affairs Health Care System, Durham, North Carolina.
Division of Behavioral Medicine and Neurosciences, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina.
Pain Med. 2022 Feb 1;23(2):295-304. doi: 10.1093/pm/pnab294.
Depression and chronic pain are major problems in American veterans, yet there is limited long-term research examining how they relate to one another in this population. This study examined the relationship between depressive symptoms and pain in U.S. veterans 50 years of age or older.
This study used data on veterans from the 2002-2016 waves of the Health and Retirement Study (n = 4,302), a large-scale observational study of Americans 50 years of age or older. Measures included a short form of the Center for Epidemiologic Studies Depression scale and two items assessing the presence and degree of pain. Analyses included random-intercept cross-lagged panel models (RI-CLPM).
In the RI-CLPM, there were roughly equivalent cross-lagged effects between depressive symptoms and pain. There was also evidence that depressive symptoms and pain have a trait-like component and that these trait-like characteristics are associated.
These findings indicate that depressive symptoms and pain in veterans are stable characteristics in American veterans 50 years of age or older. There appear to be reciprocal effects between the two, whereby deviations in one's typical depressive symptoms predict subsequent deviations in one's pain level and vice versa; however, the size of these effects is very small. These findings suggest that clinicians should treat both depressive symptoms and pain, rather than assume that treatment benefits in one domain will lead to major benefits in another.
抑郁和慢性疼痛是美国退伍军人面临的主要问题,但针对这一人群中两者之间关系的长期研究有限。本研究调查了美国 50 岁及以上退伍军人中抑郁症状与疼痛之间的关系。
本研究使用了 2002-2016 年健康与退休研究(Health and Retirement Study)中退伍军人的数据(n=4302),这是一项针对 50 岁及以上美国人的大型观察性研究。测量包括短版的流行病学研究中心抑郁量表(Center for Epidemiologic Studies Depression scale)和两项评估疼痛的存在和程度的项目。分析包括随机截距交叉滞后面板模型(random-intercept cross-lagged panel models,RI-CLPM)。
在 RI-CLPM 中,抑郁症状和疼痛之间存在大致相当的交叉滞后效应。此外,还有证据表明,抑郁症状和疼痛具有特质性成分,这些特质性特征是相关的。
这些发现表明,50 岁及以上美国退伍军人的抑郁症状和疼痛是稳定的特征。两者之间似乎存在相互影响,即一个人典型的抑郁症状的偏差预测了其疼痛水平的后续偏差,反之亦然;然而,这些影响的大小非常小。这些发现表明,临床医生应该同时治疗抑郁症状和疼痛,而不是假设在一个领域的治疗益处会带来另一个领域的重大益处。