Should We Measure Depression, Anxiety, and Anger as Distinct Mood States in Chronic Pain Patients?

摘要

Mood disturbance is common in chronic pain. Within multidisciplinary pain management programs it is now routine clinical practice to assess the levels of depression and anxiety as well as other mood states, such as fear, anger, and frustration. Depression and anxiety are usually conceptualized as distinct entities (Izard 1977; McNair et al. 1981; Schulz et al. 1994), although there is a very high concurrence of anxious and depressive disorders within clinical populations (Mountjoy and Roth 1982; Zimmerman et al. 2002). Moreover, strong correlations (>0.6) between self-rated measures of anxiety and depression have been consistently noted, and there is considerable symptom overlap between these constructs (Tanaka-Matsumi and Kameoka 1986; Watson and Clark 1992; Castern et al. 1995; Lovibond and Lovibond 1995; Gibson 1997). An alternative theoretical model of the phe-nomenological dimensions of mood emphasizes the concept of positive-negative emotion or generalized affective distress, particularly when dealing with populations that lack underlying psychiatric disease (Watson and Tellegen 1985; Schulz et al. 1994). However, the adequacy of this conceptual model for the study of mood disturbance in patients with chronic pain has yet to be fully examined.