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Der Einfluss von Katastrophisieren auf den Effekt von Depressivität auf Schmerz und körperliche Funktion

Eine längsschnittliche Mediatoranalyse

The impact of catastrophizing on the effect of depression on pain and functional ability

A longitudinal mediator analysis

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Zusammenfassung

Hintergrund

Während der Zusammenhang von Schmerz und Depressivität hinreichend belegt ist, besteht Unklarheit über die diese Beziehung beeinflussenden Mechanismen. Die kognitive Verzerrung Katastrophisieren spielt in den Konzepten beider Erkrankungen eine zentrale Rolle.

Ziel der Arbeit

Ziel der Studie war die längsschnittliche Analyse des Zusammenhangs von Depressivität und Schmerz bzw. körperlicher Funktion und des vermittelnden Einflusses von Katastrophisieren auf diese Beziehung.

Material und Methoden

Die Teilnehmer wurden in 11 ambulanten Rehabilitationseinrichtungen in Deutschland zu Beginn ihrer orthopädischen Rehabilitationsnachsorge rekrutiert. Die abhängigen Variablen Schmerzintensität, körperliche Funktionsfähigkeit (Short-Form Health Survey [SF-36]) und körperliche Funktionskapazität (Spinal Function Sort) wurden am Nachsorgebeginn (T1) und nach 6 Monaten (T2) erfasst. Die unabhängige Variable Depressivität (Patient Health Questionnaire, Skala zum psychischen Wohlbefinden des SF-36) sowie der Mediator Katastrophisieren (Coping Strategies Questionnaire) wurden zu T1 erhoben. Zur Bestimmung der direkten und indirekten Anteile des Gesamteffekts einer unabhängigen Variablen auf eine abhängige Variable unter Berücksichtigung des Mediators wurden Pfadmodelle berechnet.

Ergebnisse

241 Patienten wurden in die Analyse eingeschlossen. Depressivität hatte einen signifikanten totalen Effekt sowohl auf Schmerzintensität als auch auf körperliche Funktion. Katastrophisieren vermittelte in allen Modellen einen substanziellen Anteil dieser Effekte (42,9–87,1 %).

Diskussion

Katastrophisieren beeinflusst den Zusammenhang von Depressivität und Schmerz bzw. körperlicher Funktion. Daher sollte die Reduzierung von entsprechenden Gedanken und Einstellungen explizites Ziel in Rehabilitationsprogrammen sein.

Abstract

Background

While the association between pain and depression is well proven, little is known about the mechanisms influencing this relationship. The cognitive distortion of catastrophizing plays a significant role in several concepts of both diseases.

Objective

The aim of the study was to analyze the role of catastrophizing on the effect of depression on pain and functional ability.

Material and methods

Participants were recruited from 11 outpatient rehabilitation centers in Germany at the beginning of orthopedic rehabilitation aftercare. Perceived functional ability (spinal function sort), pain intensity (rating scales) and physical functioning (36-item Short-Form Health Survey, SF-36) were assessed as dependent variables at the beginning of the aftercare (T1) as well as 6 months later (T2). The independent variable depression (Patient Health Questionnaire and Mental Health Index of the SF-36) as well as the mediator catastrophizing (Coping Strategies Questionnaire) were measured at T1. Pathway models were used to analyze the direct and indirect proportions of the total effect of an independent variable on a dependent variable and the role of catastrophizing as a mediator of this association.

Results

A total of 241 patients were included in the analyses. Depression had a significant total effect on pain as well as functional capacity. Catastrophizing mediated substantial proportions of these effects (42.9–87.1%).

Conclusion

Catastrophizing mediates the relationship between depression and pain as well as functional capacity; therefore, the reduction of catastrophizing thoughts and attitudes should be a focus in rehabilitation programs.

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Förderung

Die Studie wurde von der Deutschen Rentenversicherung Bund gefördert.

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Authors and Affiliations

  1. Klinik für Rehabilitationsmedizin – OE 8300, Bereich Rehabilitationsforschung und -wissenschaften, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland

    J. Briest & M. Bethge

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  1. J. Briest
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Correspondence to J. Briest.

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Interessenkonflikt

J. Briest und M. Bethge geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Briest, J., Bethge, M. Der Einfluss von Katastrophisieren auf den Effekt von Depressivität auf Schmerz und körperliche Funktion. Schmerz 31, 159–166 (2017). https://doi.org/10.1007/s00482-016-0172-z

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