| 方崧颖,周冰洁,陈鸿杰,张晨娇,陈景旭.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[J].四川精神卫生杂志,2026,(3):234-239.Fang Songying,Zhou Bingjie,Chen Hongjie,Zhang Chenjiao,Chen Jingxu,Effect of anxiety symptoms on pain severity in patients with major depressive disorder： the parallel mediating roles of depressive symptoms and pain vigilance and awareness[J].SICHUAN MENTAL HEALTH,2026,(3):234-239 |
| 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 |
| Effect of anxiety symptoms on pain severity in patients with major depressive disorder： the parallel mediating roles of depressive symptoms and pain vigilance and awareness |
| 投稿时间：2026-01-27 |
| DOI：10.11886/scjsws20260127002 |
| 中文关键词: 焦虑 重性抑郁障碍 疼痛 中介分析 |
| 英文关键词:Anxiety Major depressive disorder Pain Mediation analysis |
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| 中文摘要: |
| 背景 疼痛是重性抑郁障碍（MDD）患者常见的躯体症状之一，MDD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MDD临床管理中的棘手问题。焦虑症状与MDD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MDD患者焦虑症状与疼痛程度之间的作用路径，以期为MDD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）中MDD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）以及数字评定量表（NRS）进行评定。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，MDD患者HAMD-17评分、HAMA评分、PVAQ评分及NRS评分两两之间均呈正相关（r=0.198~0.424，P<0.05或0.01）。焦虑症状可正向预测疼痛程度，直接效应值为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，间接效应值分别为0.057（95% CI：0.029~0.089）、0.042（95% CI：0.016~0.079），效应量分别为25.22%和18.58%。结论 MDD患者的焦虑症状可正向预测疼痛程度，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 one of the most common physical symptoms in patients with major depressive disorder （MDD）. The high comorbidity rate of MDD and pain aggravates patients' physical and psychological distress， undermines their treatment adherence， and contributes to poor clinical outcomes， posing a critical challenge for the clinical management of MDD. Anxiety symptoms are strongly associated with the pain severity in patients with MDD， yet the underlying mechanisms of the association remain poorly elucidated. Accumulating evidence have indicated that depressive symptoms and pain vigilance and awareness are involved in the modulation of pain perception. Nevertheless， few studies have incorporated these variables into an integrated analytical framework to clarify their parallel mediating effects on the relationship between anxiety symptoms and pain severity.Objective To explore the mediating pathways linking anxiety symptoms to pain severity via depressive symptoms and pain vigilance and awareness in patients with MDD， so as to provide insights for precise intervention for MDD accompanied by pain symptoms.Methods A total of 249 patients who met the diagnostic criteria for MDD specified in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited from Beijing Huilongguan Hospital from May to September 2025. Hamilton Depression Scale-17 item （HAMD-17）， Hamilton Anxiety Scale （HAMA）， Pain Vigilance and Awareness Questionnaire （PVAQ） and Numerical Rating Scale （NRS） were used for assessment. Partial correlation analyses were performed to examine correlations among these variables. Parallel mediating effects were tested using model 4 of the Process macro for SPSS， with depressive symptoms and pain vigilance and awareness as parallel mediators linking anxiety symptoms to pain severity.Results A total of 135 patients （54.22%） reported pain， comprising 59 （43.70%） with mild pain， 43 （31.85%） with moderate pain， and 33 （24.45%） with severe pain. Partial correlation analyses revealed significant positive correlations among HAMD-17， HAMA， PVAQ， and NRS scores in patients with MDD （r=0.198–0.424， P<0.05 or 0.01）. Anxiety symptoms positively predicted pain severity， with a direct effect of 0.128 （95% CI： 0.065–0.190）. Both depressive symptoms and pain vigilance and awareness acted as partial mediators linking anxiety symptoms to pain severity. The indirect effects were 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 In patients with MDD， anxiety symptoms exert a positive predictive effect on pain severity， which is partially mediated through the parallel roles of depressive symptoms and pain vigilance and awareness. |
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