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DOI: 10.1055/s-0034-1387563
Schmerzsymptome als Hinweis auf Depressionen und Angsterkrankungen bei PatientInnen an somatischen Krankenhausabteilungen
Pain Symptoms as Predictors of Depressive or Anxiety Disorders in Patients with Physical IllnessPublication History
Publication Date:
17 April 2015 (online)
Zusammenfassung
Anliegen: Ziel war den Zusammenhang zwischen Schmerzen und Depressionen sowie Angststörungen bei somatisch Kranken zu untersuchen.
Methode: Schmerzen wurden bei 290 PatientInnen somatischer Krankenhausabteilungen mittels Fragebogen erfasst, die psychiatrischen Diagnosen mittels eines standardisierten Interviews durch PsychiaterInnen.
Ergebnisse: Somatisch Kranke mit einer komorbiden psychischen Krankheit leiden signifikant häufiger an Schmerzsymptomen.
Schlussfolgerung: Schmerzen können ein wichtiger Hinweis auf das Vorhandensein von affektiven oder Angsterkrankungen sein.
Abstract
Objective: The aim of this study was to investigate the frequency of pain symptoms reported by patients of non-psychiatric hospital departments and to explore their association with affective and anxiety disorders.
Methods: Patients of non-psychiatric hospital departments (n = 290) reported pain symptoms by filling in a self-rating questionnaire. Psychiatric examinations were performed by psychiatrists using a structured diagnostic interview. The sum-scores of self-reported pain symptoms were tested for their screening accuracy for anxiety and depression.
Results: Patients suffering from affective or anxiety disorders reported significantly more often three or more pain symptoms (63 % vs. 28 %). Using a cut-off value of ≥ 3 of self-reported pain symptoms yielded a sensitivity of 63.1 % and a specificity of 71.7 %.
Conclusions: These findings highlight the relevance of a higher number of pain symptoms as a possible indicator for affective and anxiety disorders. The use of pain symptoms as pre-screening for depression and anxiety might be a useful tool, but needs further research before it can be recommended.
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Literatur
- 1 Leadley RM, Armstrong N, Lee YC et al. Chronic diseases in the European Union. The prevalence and health cost implications of chronic pain. J Pain Palliat Care Pharmacother 2012; 26: 310-325
- 2 Klimont J, Kytir J, Leitner B. Österreichische Gesundheitsbefragung 2006/2007. Wien: Bundesanstalt Statistik Österreich; 2007
- 3 Bruster S, Jarman B, Bosanquet N et al. National survey of hospital patients. BMJ 1994; 309: 1542-1546
- 4 Dix P, Sandhar B, Murdoch J et al. Pain on medical wards in a district general hospital. Br J Anaesth 2004; 92: 235-237
- 5 Rockett MP, Simpson G, Crossley R et al. Characteristics of pain in hospitalized medical patients, surgical patients and outpatients attending a pain management centre. Br J Anaesth 2013; 18: 1-7
- 6 Scott KM, Oakley Browne MA, McGee MA et al. Mental-physical comorbidity in Te Rau Hinengaro: The New Zealand Mental Health Survey. Aust N Z J Psychiatry 2006; 40: 882-888
- 7 Von Korff M, Dworkin SF, Le Resche L. An epidemiologic comparison of pain complaints. Pain 1988; 32: 173-183
- 8 Saastamoinen P, Laaksonen M, Kääriä SM et al. Pain and disability retirement: A prospective cohort study. Pain 2012; 153: 526-531
- 9 Kessler RC, Chiu WT, Demler O et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 2005; 62: 617-627
- 10 Katon WJ, Russo JE, Von Korff M et al. Long-term effects on medical costs of improving depression outcomes in patients with depression and diabetes. Diabetes Care 2008; 31: 1155-1159
- 11 Hörtnagl CM, Oberheinricher S, Hofer A. Soziale Kognition bei PatientInnen mit affektiven Störungen: Teil I: Unipolar Depressive Störung. Neuropsychiatr 2014; 28: 74-83
- 12 Baumeister H, Knecht A, Hutter N. Direct and indirect costs in persons with chronic back pain and comorbid mental disorders – A systematic review. J Psychosom Res 2012; 73: 79-85
- 13 Salize H-J, Jacke C, Gallas C et al. Krankenkassengestütztes Case-Management verbessert kostenneutral die Behandlungsqualität bei affektiven Störungen. Psychiat Prax 2014; 41: 432-438
- 14 Jacke C, Salize HJ. Kosteneffektivität eines krankenkassengestützten Case-Management-Programms für Patienten mit affektiven Störungen. Neuropsychiatr 2014; 28: 130-141
- 15 Wancata J, Benda N, Bach M et al. Recognition of psychiatric disorders in nonpsychiatric hospital wards. J Psychosom Res 2000; 48: 149-155
- 16 US Preventive Services Task Force. Screening for depression. Recommendations and rational. Ann Intern Med 2002; 136: 760-764
- 17 Friedrich F, Alexandrowicz R, Benda N et al. The criterion validity of different versions of the General Health Questionnaire among non-psychiatric inpatients. Soc Psychiatry Psychiatr Epidemiol 2011; 46: 635-641
- 18 Alexandrowicz R, Fritzsche S, Keller F. Die Anwendbarkeit des BDI-II in klinischen und nichtklinischen Populationen aus psychometrischer Sicht. Eine vergleichende Analyse mit dem Rasch-Modell. Neuropsychiatr 2014; 28: 63-73
- 19 Arroll B, Khin N, Kerse N. Screening for depression in primary care with two verbally asked questions: cross sectional study. BMJ 2003; 327: 1144-1146
- 20 White JE. A two stage design for the study of the relationship between a rare exposure and a rare disease. Am J Epidemiol 1982; 115: 119-128
- 21 Alexandrowicz R, Weiss M, Marquart B et al. Zur Validität zweistufigen Screenings am Beispiel Depressionsscreening. Psychiat Prax 2008; 35: 294-301
- 22 Monsch AU, Bondi MW, Butters N et al. Comparisons of verbal fluency tasks in the detection of dementia of Alzheimer type. Arch Neurol 1992; 49: 1253-1258
- 23 Spitzer RL, Williams JB, Kroenke K et al. Utility of a new procedure for diagnosing mental disorders in primary care. The PRIME-MD 1000 study. JAMA 1994; 272: 1749-1756
- 24 Spiegel W, Tönies H, Scherer M et al. Learning by doing: a novel approach to improving general practitioners’ diagnostic skills for common mental disorders. Wien Klin Wochenschr 2006; 118: 1-7
- 25 Sibitz I, Berger P, Freidl M et al. ICD-10 or DSM-IV? Anhedonia, fatigue and depressed mood as screening symptoms for diagnosing a current depressive episode in physically ill patients in general hospital. J Affect Disord 2010; 126: 245-251
- 26 Wittchen HU, Pfister H. DIA-X-Interviews. Manual für Screening-Verfahren und Interview. Frankfurt: Swets & Zeitlinger; 1997
- 27 Knaster P, Karlsson H, Estlander AM et al. Psychiatric disorders as assessed with SCID in chronic pain patients: The anxiety disorders precede the onset of pain. Gen Hosp Psychiatry 2012; 34: 46-52
- 28 Rief W, Martin A. How to use DSM-V somatic syndrome disorder diagnosis in research and practice: A critical evaluation and a proposal for modifications. Annu Rev Clin Psychol 2014; 10: 339-367
- 29 Dworkin SF, Von Korff M, LeResche L. Multiple pains and psychiatric disturbance. An epidemiologic investigation. Arch Gen Psychiatry 1990; 47: 239-244
- 30 Minsky S, Etz RS, Gara M. Service use among patients with serious mental illnesses who presented with physical symptoms at intake. Psychiatr Serv 2011; 62: 1146-1151
- 31 Bair MJ, Robinson RL, Katon W et al. Depression and Pain Comorbidity: A Literature Review. Arch Intern Med 2003; 163: 2433-2445
- 32 Burke WJ, Roccaforte WH, Wengel SP. The short form of the Geriatric Depression Scale: a comparison with the 30-item form. J Geriatr Psychiatry Neurol 1991; 4: 173-178
- 33 Van Marwijk HW, Wallace P, De Bock GH et al. Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale. Br J Gen Pract 1995; 45: 195-199
- 34 Burke WJ, Rangwani S, Roccaforte WH et al. The reliability and validity of the collateral source version of the Geriatric Depression Rating Scale administered by telephone. Int J Geriatr Psychiatry 1997; 12: 288-294
- 35 Rinaldi P, Mecocci P, Benedetti C et al. Validation of the five-item geriatric depression scale in elderly subjects in three different settings. J Am Geriatr Soc 2003; 51: 694-698
- 36 Blank K, Gruman C, Robison JT. Case-finding for depression in elderly people: balancing ease of administration with validity in varied treatment settings. J Gerontol B Psychol Sci Soc Sci 2004; 59: 378-384
- 37 Fritzsche K, Schindler C, Eichenlaub J et al. Der Einsatz von Pflegepersonal im Psychosomatischen Konsil- und Liaisondienst. Psychiat Prax 2013; 40: 356-357