焦虑症状对重性抑郁障碍患者疼痛程度的影响：抑郁症状、疼痛警觉性与意识的平行中介作用

The Effect of Anxiety Symptoms on Pain Severity in Major Depressive Disorder Patients: The Pathway of Depressive Symptoms, Pain Vigilance and Awareness

中文关键词:  焦虑  重性抑郁障碍  疼痛测量  中介分析

英文关键词:Anxiety  Major Depressive disorder  Pain Measurement  Mediation Analysis

中文摘要:

      背景 疼痛是重性抑郁障碍患者常见的躯体化症状之一，重性抑郁障碍与疼痛的高共病率不仅加重患者的身心痛苦，降低治疗依从性，还导致预后不良，已成为重性抑郁障碍临床管理中的棘手问题。焦虑症状与重性抑郁障碍患者的疼痛程度密切相关，但其调控机制尚不明确。尽管有证据提示抑郁症状、疼痛警觉性与意识可能参与疼痛感知的调节，但鲜有研究将二者纳入同一分析框架，探究其在焦虑症状与疼痛程度之间的中介作用。目的 探究抑郁症状和疼痛警觉性与意识在重性抑郁障碍患者焦虑症状与疼痛程度之间的作用路径，以期为重性抑郁障碍伴发疼痛的精准干预提供参考。方法 选取2025年5月—9月在北京回龙观医院就诊、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）重性抑郁障碍诊断标准的患者249例。采用汉密尔顿抑郁量表17项版（HAMD-17）、汉密尔顿焦虑量表（HAMA）、疼痛警觉性与意识问卷（PVAQ）、数字评定量表（NRS）分别评定抑郁症状、焦虑症状、疼痛警觉性与意识以及疼痛程度。采用偏相关分析考查各量表评分之间的相关性。采用SPSS Process宏程序的模型4，分析抑郁症状、疼痛警觉性与意识在焦虑症状与疼痛程度之间的中介效应。结果 检出135例（54.22%）患者存在疼痛，其中轻度疼痛59例（43.70%），中度疼痛43例（31.85%）、严重疼痛33例（24.45%）。偏相关分析结果显示，NRS评分与HAMD-17评分、HAMA评分、PVAQ评分均呈正相关（r=0.417、0.424、0.414，P均<0.01），HAMD-17评分与HAMA评分、PVAQ评分均呈正相关（r=0.411、0.198，P<0.05或0.01），HAMA评分与PVAQ评分呈正相关（r=0.281，P<0.01）。焦虑症状对疼痛程度的直接效应量为0.128（95% CI：0.065~0.190）；抑郁症状和疼痛警觉性与意识分别在焦虑症状与疼痛程度之间发挥部分中介作用，二者的间接效应值分别为0.057（95% CI：0.029~0.089）、0.042（95% CI：0.016~0.079），分别占总效应的25.22%和18.58%。结论 重性抑郁障碍患者焦虑症状可以正向预测疼痛程度，也可以通过抑郁症状和疼痛警觉性与意识的平行中介作用介导。

英文摘要:

      Background Pain is the most common somatic symptom in patients with major depressive disorder, and the high comorbidity not only exacerbates patients'' physical and psychological distress, but also reduces treatment adherence and leads to poor prognosis, becoming a major difficulty in the clinical management of major depressive disorder. Existing studies have confirmed that anxiety symptoms are closely associated with pain severity in patients with major depressive disorder, yet the regulatory mechanism of anxiety symptoms on pain severity remains unclear. Although several studies have suggested that depressive symptoms, as well as pain vigilance and awareness, may be involved in the regulation of pain perception, few have incorporated these two factors into a single analytical framework to explore their mediating effects and specific effect proportions in the relationship between anxiety symptoms and pain severity. In view of this, the present study constructed a parallel mediation model to clarify the mediating pathways of depressive symptoms, pain vigilance and awareness in the above relationship, so as to provide a theoretical basis for the precise intervention of pain comorbid with depression. Objective To investigate the mediating roles of depressive symptoms and pain vigilance and awareness in the relationship between anxiety symptoms and pain severity in depressed patients, providing insights for clinical management. Methods A total of 249 patients treated at Beijing Huilongguan Hospital from May to September 2025 who met the diagnostic criteria for major depressive disorder according to The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) were selected. A self-designed questionnaire was used to collect general demographic and clinical data. The 17-item Hamilton Depression Rating Scale(HAMD-17), Hamilton Anxiety Rating Scale (HAMA), 16-item Pain Vigilance and Awareness Questionnaire (PVAQ), and 11-point Numerical Rating Scale (NRS) were administered to assess depressive symptoms, anxiety symptoms, pain vigilance and awareness, and pain severity, respectively. Model 4 of the SPSS Process macro was used to conduct the mediation effect analysis of depressive symptoms and pain vigilance and awareness in the relationship between anxiety symptoms and pain severity. Results Pain was detected in 135 patients (54.22%). Among them, mild pain was present in 59 cases (43.70%), moderate pain in 43 cases (31.85%), and severe pain in 33 cases (24.45%). Partial correlation analysis showed that NRS scores were positively correlated with HAMD-17 scores, HAMA scores, and PVAQ scores (r=0.424, 0.417, 0.414, P<0.01). HAMD-17 scores were positively correlated with HAMA scores and PVAQ scores (r=0.411, 0.198, P<0.01), and HAMA scores were positively correlated with PVAQ scores (r=0.281, P<0.01). The direct effect of anxiety symptoms on pain severity was 0.128 (95% CI: 0.065-0.190). Mediation effect analysis indicated that depressive symptoms and pain vigilance and awareness each mediated the relationship between anxiety symptoms and pain severity, with indirect effect values of 0.057 (95% CI: 0.029–0.089) and 0.042 (95% CI: 0.016–0.079), accounting for 25.22% and 18.58% of the total effect, respectively. Conclusion Anxiety symptoms in patients with depression can positively predict pain severity, and also exert a mediating effect through depressive symptoms, pain vigilance and pain awareness.