不同自伤与自杀风险表型的抑郁症患者疼痛特征及其与风险表型的关系

Pain characteristics of patients with depression disorder across different self-injury/suicide risk phenotypes and their associations with the risk phenotypes

中文关键词:  抑郁症  自杀风险  自伤行为  疼痛

英文关键词:Depression disorder  Suicide risk  Self-injury behavior  Pain

中文摘要:

      背景 抑郁症患者的自杀或自伤风险与疼痛症状相关，但不同疼痛类型及其严重程度与不同自伤/自杀风险表型之间的关系仍存在争议。目的 探讨躯体疼痛是否能够反映不同自伤/自杀风险表型，为临床识别抑郁症患者的自杀与自伤风险提供参考。方法 基于全国抑郁症状学调查（NSSD）数据，招募符合《精神障碍诊断与统计手册（第4版）》修订版（DSM-IV-TR）重度抑郁障碍诊断标准的患者3 275例，根据既往自杀行为、过去两周自杀意念及自伤行为，将患者分为无自伤/自杀风险组、自伤组及自杀高风险组。采用NSSD结构化症状评估工具，评定患者头痛、肌肉酸痛、躯干疼痛、肢体疼痛以及其他疼痛症状的发生情况。以无自伤/自杀风险组为参照，采用有序Logistic回归模型分析不同风险组与疼痛发生频率的关联，并将人口学资料及临床资料作为协变量进行调整。结果 共3 211例（98.05%）患者纳入分析，其中，无自伤/自杀风险组1 329例（41.39%），自伤组415例（12.92%），自杀高风险组1 467例（45.69%）。与无自伤/自杀风险组相比，自伤组头痛（OR=1.526，95% CI：1.221~1.894）和肌肉酸痛（OR=1.287，95% CI：1.034~1.597）发生频率较高；自杀高风险组头痛（OR=0.583，95% CI：0.504~0.672）、肌肉酸痛（OR=0.682，95% CI：0.597~0.780）、躯干疼痛（OR=0.557，95% CI：0.475~0.634）、肢体疼痛（OR=0.454，95% CI：0.384~0.522）以及其他难以明确定位的疼痛（OR=0.542，95% CI：0.472~0.631）的发生频率均较低。结论 不同自伤与自杀风险表型的抑郁症患者呈现出不同的疼痛特征，这些差异可能为临床识别抑郁症患者的自杀与自伤风险提供参考。

英文摘要:

      Background Suicide and self-injury risk in patients with depression disorder is associated with pain symptoms， but the relationships between specific pain types and their severity and distinct self-injury/suicide risk phenotypes remain controversial.Objective To explore whether somatic pain can reflect different self-injury/suicide risk phenotypes， and to provide references for the clinical identification of suicide and self-injury risk in patients with depression.Methods Based on data from the National Survey on Symptomatology of Depression （NSSD）， 3 275 patients who met the diagnostic criteria for major depressive disorder in the Diagnostic and Statistical Manual of Mental Disorders， fourth edition， text revision （DSM-IV-TR） were recruited. According to previous suicidal behavior， suicidal ideation and self-injury behavior in the past two weeks， patients were divided into the no self-injury/suicide risk group， self-injury group， and high suicide-risk group. The occurrence of headache， muscle soreness， trunk pain， limb pain， and other pain symptoms was assessed using the structured symptom assessment instrument of the NSSD. With the no self-injury/suicide risk group as the reference， an ordinal Logistic regression model was used to analyze the associations between the risk groups and the occurrence frequency of pain， with demographic and clinical characteristics entered into the model as covariates for adjustment.Results A total of 3 211 patients （98.05%） were included in the analysis， including 1 329 cases （41.39%） in the no self-injury/suicide risk group， 415 cases （12.92%） in the self-injury group， and 1 467 cases （45.69%） in the high suicide-risk group. Compared with the no self-injury/suicide risk group， the occurrence frequencies of headache （OR=1.526， 95% CI： 1.221–1.894） and muscle soreness （OR=1.287， 95% CI： 1.034–1.597） were higher in the self-injury group， and the occurrence frequencies of headache （OR=0.583， 95% CI： 0.504–0.672）， muscle soreness （OR=0.682， 95% CI： 0.597–0.780）， trunk pain （OR=0.557， 95% CI： 0.475–0.634）， limb pain （OR=0.454， 95% CI： 0.384–0.522）， and other pain difficult to localize （OR=0.542， 95% CI： 0.472–0.631） were all lower in the high suicide-risk group.Conclusion Patients with depression disorder across different self-injury and suicide risk phenotypes exhibit distinct pain characteristics， and these differences may provide a reference for the clinical identification of suicide and self-injury risk in patients with depression disorder. ［Funded by The National Key Research and Development Program of China during the "13th Five-Year Plan" period （number， 2016YFC1307100）； Shanghai Key Clinical Specialties Construction Project］