Roth Maya, King Lisa, Richardson Don
St. Joseph's Operational Stress Injury Clinic, St. Joseph's Health Care London, London, ON N6C 5J1, Canada.
Mil Med. 2023 May 16;188(5-6):e1150-e1155. doi: 10.1093/milmed/usab532.
Chronic pain (CP) commonly presents alongside psychiatric conditions such as depression, PTSD, and generalized anxiety. The current study sought to better understand this complex relationship by determining whether anxiety and depression symptom severity mediated the relationship between DSM-5 PTSD symptom clusters and pain symptoms in a sample of 663 Canadian Armed Forces (CAF) personnel and veterans seeking treatment for mental health conditions.
Generalized anxiety disorder, depression, and PTSD symptom severity were measured using self-report scales provided as part of a standard intake protocol. Pain symptoms were measured using the Bodily Pain subscale of the SF-36 (SF-36 BPS). Linear regressions were used to explore the relationship between PTSD symptom clusters, depression, anxiety, and pain. Bootstrapped resampling analyses were employed to test mediation effects.
The average SF-36 BPS score in this sample was 36.6, nearly 1.5 SDs below the population health status, enforcing the salience of pain symptoms as a concern for veterans and CAF seeking treatment for military-related psychiatric conditions. The effects of PTSD symptom clusters avoidance, negative mood and cognitions, and arousal on pain were fully mediated by anxiety and depression severity. However, the effect of intrusion on pain was not mediated by depression and only partly mediated by anxiety.
Findings emphasize the importance of including anxiety and depression in models of PTSD and pain, particularly in samples where psychiatric comorbidity is high. Clinically, results highlight the need for improved treatment regimens that address pain symptoms alongside common psychiatric comorbidities.
慢性疼痛（CP）通常与抑郁症、创伤后应激障碍（PTSD）和广泛性焦虑症等精神疾病同时出现。本研究旨在通过确定焦虑和抑郁症状严重程度是否介导了663名寻求心理健康治疗的加拿大武装部队（CAF）人员和退伍军人样本中DSM-5 PTSD症状群与疼痛症状之间的关系，来更好地理解这种复杂关系。
使用作为标准入院协议一部分提供的自我报告量表来测量广泛性焦虑症、抑郁症和PTSD症状严重程度。使用SF-36的身体疼痛分量表（SF-36 BPS）来测量疼痛症状。采用线性回归来探索PTSD症状群、抑郁症、焦虑症和疼痛之间的关系。采用自抽样分析来检验中介效应。
该样本中SF-36 BPS的平均得分为36.6，比总体健康状况低近1.5个标准差，这突出了疼痛症状对于寻求与军事相关精神疾病治疗的退伍军人和CAF人员的重要性。PTSD症状群中的回避、消极情绪和认知以及觉醒对疼痛的影响完全由焦虑和抑郁严重程度介导。然而，闯入对疼痛的影响并非由抑郁症介导，仅部分由焦虑症介导。
研究结果强调了在PTSD和疼痛模型中纳入焦虑和抑郁的重要性，特别是在精神疾病共病率较高的样本中。在临床上，结果突出了需要改进治疗方案，以同时解决疼痛症状和常见的精神疾病共病问题。
