Saba Shaddy K, Davis Jordan P, Prindle John J, Howe Esther, Tran Denise D, Bunyi John, Hummer Justin F, Castro Carl Andrew, Pedersen Eric R
From the Suzanne Dworak-Peck School of Social Work (Saba, Davis, Prindle, Bunyi, Castro), University of Southern California, Los Angeles; Department of Psychology (Howe), University of California, Berkeley, Berkeley; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine (Tran, Pedersen), University of Southern California, Los Angeles; and RAND Corporation (Hummer), Santa Monica, California.
Psychosom Med. 2024 Jan 1;86(1):44-51. doi: 10.1097/PSY.0000000000001253.
Military veterans who were injured in combat very often report pain along with co-occurring perceived stress and preexisting depressive disorder. The systems model of pain is a theoretical model suggesting that pain and perceived stress are bidirectionally associated at the within-person level, and associations are heightened among those with depressive disorder. However, the systems model of pain has not been adequately tested. Testing the systems model of pain could illuminate salient treatment targets for combat-injured veterans with pain and co-occurring psychological problems.
The present study empirically tests the systems model of pain among a sample of combat-injured veterans ( N = 902) surveyed five times during an 18-month period. We used a multigroup, autoregressive latent trajectory with structured residual statistical model to test the within-person associations between pain and perceived stress and determine whether associations differ between veterans with and without a positive screen for depressive disorder.
In line with the systems model of pain, pain and perceived stress were bidirectionally associated only among combat-injured veterans with depressive disorder. Among such veterans, perceived stress was positively associated with subsequent pain ( b = 0.12; 95% confidence interval = 0.06-0.17), and pain was positively associated with subsequent perceived stress ( b = 0.44; 95% CI = 0.11-0.77).
Our work highlights the interplay between pain and its psychological correlates among a particularly at-risk population. Clinicians addressing pain and perceived stress among combat-injured veterans should be prepared to identify and address depressive disorder.
在战斗中受伤的退伍军人经常报告疼痛，同时伴有感知到的压力和先前存在的抑郁症。疼痛系统模型是一种理论模型，表明疼痛和感知到的压力在个体层面上是双向关联的，并且在患有抑郁症的人群中这种关联更为强烈。然而，疼痛系统模型尚未得到充分验证。验证疼痛系统模型可以为患有疼痛和并发心理问题的战斗受伤退伍军人阐明显著的治疗靶点。
本研究对902名战斗受伤退伍军人样本在18个月内进行了5次调查，以实证检验疼痛系统模型。我们使用了具有结构化残差统计模型的多组自回归潜在轨迹来检验疼痛与感知压力之间的个体内关联，并确定在抑郁症筛查呈阳性和阴性的退伍军人之间这种关联是否存在差异。
与疼痛系统模型一致，疼痛和感知压力仅在患有抑郁症的战斗受伤退伍军人中呈双向关联。在这类退伍军人中，感知压力与随后的疼痛呈正相关（b = 0.12；95%置信区间 = 0.06 - 0.17），疼痛与随后的感知压力呈正相关（b = 0.44；95%置信区间 = 0.11 - 0.77）。
我们的研究突出了在一个特别高危人群中疼痛与其心理相关因素之间的相互作用。治疗战斗受伤退伍军人疼痛和感知压力的临床医生应准备好识别和处理抑郁症。
