Data from: Diagnosing depression in chronic pain patients: DSM-IV Major Depressive Disorder vs. Beck Depression Inventory (BDI)

Background: Diagnosing depression in chronic pain is challenging due to overlapping somatic symptoms. In questionnaires, such as the Beck Depression Inventory (BDI), responses may be influenced more by pain than by the severity of depression. In addition, previous studies have suggested that symptoms of negative self-image, a key element in depression, are uncommon in chronic pain-related depression. The object of this study is to assess the relationship of the somatic and cognitive-emotional items of BDI with the diagnosis of depression, pain intensity, and disability. Methods: One hundred consecutive chronic pain patients completed the Structured Clinical Interview for DSM Disorders (SCID) for the diagnosis of major depressive disorder (MDD) according to DSM-IV. Two subscales of BDI (negative view of self and somatic-physical function) were created according to the factor model presented by Morley. Results: In the regression analysis, the somatic-physical function factor associated with MDD, while the negative view of self factor did not. Patients with MDD had higher scores in several of the BDI items when analysed separately. Insomnia and weight loss were not dependent on the depression diagnosis. Limitations: The relatively small sample size and the selected patient sample limit the generalisability of the results. Conclusions: Somatic symptoms of depression are also common in chronic pain and should not be excluded when diagnosing depression in pain patients. Regardless of the assessment method, diagnosing depression in chronic pain remains a challenge and requires careful interpretation of symptoms.背景：由于躯体症状存在重叠，慢性疼痛患者的抑郁症诊断颇具挑战。在贝克抑郁量表（Beck Depression Inventory, BDI）等问卷中，作答结果受疼痛影响的程度往往甚于抑郁严重程度。此外，既往研究表明，作为抑郁症核心要素的负面自我意象症状，在慢性疼痛相关性抑郁症中并不常见。本研究旨在探讨贝克抑郁量表的躯体症状条目与认知情绪条目，分别与抑郁症诊断、疼痛强度及功能残疾的关联。 方法：本研究纳入100例连续性慢性疼痛患者，依据《精神障碍诊断与统计手册第四版》（DSM-IV）标准，采用精神障碍诊断与统计手册结构化临床访谈（Structured Clinical Interview for DSM Disorders, SCID）完成重性抑郁障碍（Major Depressive Disorder, MDD）的诊断。参照莫利（Morley）提出的因子模型，本研究构建了贝克抑郁量表的两个子量表：负面自我认知维度与躯体生理功能维度。 结果：回归分析显示，躯体生理功能维度与重性抑郁障碍存在显著关联，而负面自我认知维度则无此关联。单独分析各条目时，重性抑郁障碍患者在多项贝克抑郁量表条目上得分更高。失眠与体重减轻症状与抑郁症诊断并无关联。 局限性：本研究样本量相对较小，且为选择性患者样本，因此结果的外推性受到一定限制。 结论：抑郁症的躯体症状在慢性疼痛患者中同样普遍，因此对疼痛患者进行抑郁症诊断时，不应将此类躯体症状排除在评估参考之外。无论采用何种评估手段，慢性疼痛患者的抑郁症诊断仍具挑战，需对症状进行审慎解读。