现役军人的临床抑郁、焦虑与慢性疼痛之间的关联。

Association Between Clinical Depression, Anxiety, and Chronic Pain in the Active Duty Army Personnel.

机构信息

Womack Army Medical Center, Department of Family Medicine, Fort Bragg, NC 28310, USA.

Department of Research and Medical Education, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, USA.

出版信息

Mil Med. 2023 Nov 8;188(Suppl 6):311-315. doi: 10.1093/milmed/usad126.

DOI:10.1093/milmed/usad126

PMID:37948263

Abstract

INTRODUCTION

Chronic pain is highly prevalent among soldiers leading to costly impacts on disability and readiness. Depression and anxiety (D&A) are frequently comorbid with chronic pain, but previous studies tend to focus on reporting the odds of co-occurrence. The aim of this study was to examine the association of properly diagnosed D&A disorders on chronic pain indicators among active duty soldiers.

MATERIALS AND METHODS

Data were drawn from the intake assessments of 203 soldiers seen at an Interdisciplinary Pain Management Center. The Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria and the D&A subscales of the Patient Health Questionnaire were used to identify patients who met criteria for clinical depression or anxiety. Of the 203 patients, 129 met neither depression nor anxiety criteria (No D&A), 12 met clinical depression criteria only, 16 met clinical anxiety only, and 46 showed coexisting D&A disorders. The D&A and No D&A groups were compared using validated measures to assess the pain intensity rating and pain effect on well-being, physical functioning, and catastrophizing tendency. Data were analyzed using descriptive statistics and independent samples t-test analyses.

RESULTS

Significant differences were found between the D&A and No D&A groups on all pain-related measures (all Ps < .001). Patients in the D&A group reported higher average intensity of pain (6.11 versus 5.05) and greater effect of pain on activity (6.91 versus 5.37), sleep (7.20 versus 4.90), emotional state (7.74 versus 4.47), and stress (8.13 versus 4.78). Depression and anxiety patients also reported higher pain-catastrophizing tendency (38.56 versus 18.50) and greater physical disability (18.20 versus 12.22).

CONCLUSIONS

Soldiers who have chronic pain with coexisting D&A disorders experience a greater degree of perceived negative impacts. Consequently, attentiveness to proper diagnosis and treatment of coexisting clinical mood disorders is an essential step in fully addressing chronic pain management.

摘要

引言

慢性疼痛在士兵中普遍存在，导致残疾和战备能力的代价高昂。抑郁和焦虑（D&A）与慢性疼痛常常并存，但以前的研究往往侧重于报告共病的几率。本研究的目的是检查在现役士兵中，经过适当诊断的 D&A 障碍与慢性疼痛指标之间的关联。

材料和方法

数据来自于 203 名在跨学科疼痛管理中心就诊的士兵的入院评估。使用《精神疾病诊断与统计手册》第 5 版的诊断标准和患者健康问卷的 D&A 子量表来识别符合临床抑郁或焦虑标准的患者。在 203 名患者中，129 名既不符合抑郁也不符合焦虑标准（无 D&A），12 名仅符合临床抑郁标准，16 名仅符合临床焦虑标准，46 名显示同时存在 D&A 障碍。使用验证过的测量方法对 D&A 组和无 D&A 组进行比较，以评估疼痛强度评分以及疼痛对幸福感、身体功能和灾难化倾向的影响。使用描述性统计和独立样本 t 检验分析进行数据分析。

结果

在所有与疼痛相关的测量中，D&A 组和无 D&A 组之间存在显著差异（均 P<.001）。D&A 组的患者报告疼痛平均强度更高（6.11 比 5.05），疼痛对活动（6.91 比 5.37）、睡眠（7.20 比 4.90）、情绪状态（7.74 比 4.47）和压力（8.13 比 4.78）的影响更大。抑郁和焦虑患者还报告了更高的疼痛灾难化倾向（38.56 比 18.50）和更大的身体残疾（18.20 比 12.22）。