Understanding Pain and Depression in Back Pain: the Role of Catastrophizing, Help-/Hopelessness, and Thought Suppression as Potential Mediators
- 526 Downloads
The cognitive mediation hypothesis describes the influence of psychological factors on the relationship between pain and depression such as cognitions of catastrophizing and help-/hopelessness. More recent research also emphasizes the role of suppression of negative thoughts and experiences such as pain. However, there is little research investigating direct and indirect effects of these contrasting cognitions.
A total of 164 acute and sub-acute non-specific back pain patients participated in this study. Pain intensity, depression, and pain-related cognitions were measured using questionnaires, such as the Beck Depression Inventory and the Kiel Pain Inventory. Data were analyzed using structural equation modeling.
The results of the path analysis support the hypothesis that cognitive coping strategies have a mediating effect on pain and depression. Consistent with previous research, we found that pain had no direct relation with depression. Help-/hopelessness had a direct path to depression, whereas catastrophizing had an indirect effect via increased help-/hopelessness. The current results also indicate that thought suppression mediated the relationship between pain and depression via both direct and indirect effects.
Cognitive mediators, such as help-/hopelessness, catastrophizing, and thought suppression, have a significant impact on depression in patients with acute and sub-acute back pain. The current results may aid in the optimization of treatments for these patients by focusing attention toward the modification of dysfunctional cognitive pain-coping strategies.
KeywordsDepression Sub-acute back pain Catastrophizing Help-/hopelessness Thought suppression
This study was supported by a research grant from the German Research Foundation (DFG: HA 1684) awarded to MIH.
The manuscript was edited by American Journal Experts. Costs of this service were incurred by the authors’ department (Department of Medical Psychology and Medical Sociology, Ruhr-University Bochum).
Compliance with Ethical Standards
All procedures followed in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients being included in the study.
Conflict of Interest
The authors declare that they have no competing interests.
- 33.Seligman ME. Helplessness: on depression, development, and death. San Francisco: Freeman; 1975.Google Scholar
- 34.Hasenbring M. The Kiel Pain Inventory-Manual. Three questionnaire scales for assessment of pain-related cognitions, emotions and coping-strategies. Bern: Huber Verlag; 1994.Google Scholar
- 36.Lazarus RS, Folkman S. Stress appraisal, and coping. New York: Springer; 1984.Google Scholar
- 40.Hasenbring MI, Hallner D, Rusu AC. Endurance-related pain responses in the development of chronic back pain. In: Hasenbring MI, Rusu AC, Turk DC, editors. From acute to chronic back pain. Risk factors, mechanisms, and clinical implications. New York: Oxford University Press; 2012. p. 295–314.CrossRefGoogle Scholar
- 43.Wegner DM. You cannot always think what you want: problems in the suppression of unwanted thoughts. In: Zanna M, editor. Advances in experimental social psychology. San Diego: Academic; 1992. p. 193–225.Google Scholar
- 51.First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV axis I disorders. Arlington: American Psychiatric Publishing; 1997.Google Scholar
- 69.Kline RB. Principles and practice of structural equation modeling. 2nd ed. New York: The Guilford Press; 2005.Google Scholar
- 70.Schumacker R, Lomax R. A beginners guide to structural equation modelling, 2nd Edition. Lawrence Erlbaum Associates, 2004.Google Scholar
- 72.Corp IBM. IBM SPSS statistics for Windows, version 22.0. Armonk: IBM Corp; 2013.Google Scholar
- 73.Arbuckle JL. Amos version 7.0. Chicago: SPSS; 2006.Google Scholar
- 74.Byrne BM. Structural equation modelling with Amos: basic concepts, applications and programming. New Jersey: Lawrence Erlbaum Associates; 2001.Google Scholar
- 75.Browne MW, Cudeck R. Alternative ways of assessing model fit. In: Bollen KA, Long JS, editors. Testing structural equation models. Newbury Park: Sage; 1993. p. 136–62.Google Scholar
- 76.Fahland RA, Kohlmann T, Hasenbring M, Feng YS, Schmidt CO. Which route leads from chronic back pain to depression? A path analysis on direct and indirect effects using the cognitive mediators catastrophizing and helplessness/hopelessness in a general population sample. Schmerz. 2012;26:685–91.CrossRefPubMedGoogle Scholar
- 85.Kennedy-Moore E, Watson JC. Expressing emotion: myths, realities, and therapeutic strategies. New York: Guilford; 1999.Google Scholar
- 86.Hayes SC, Strosahl K, Wilson KG. Acceptance and commitment therapy: an experiential approach to behavior change. New York: Guildford; 1999.Google Scholar