Understanding Pain and Depression in Back Pain: the Role of Catastrophizing, Help-/Hopelessness, and Thought Suppression as Potential Mediators

  • Janina Hülsebusch
  • Monika I. HasenbringEmail author
  • Adina C. Rusu



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.


Depression 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.


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Copyright information

© International Society of Behavioral Medicine 2015

Authors and Affiliations

  • Janina Hülsebusch
    • 1
  • Monika I. Hasenbring
    • 1
    Email author
  • Adina C. Rusu
    • 1
    • 2
  1. 1.Department of Medical Psychology and Medical Sociology, Faculty of MedicineRuhr-University BochumBochumGermany
  2. 2.Department of Psychology, Royal HollowayUniversity of LondonLondonUK

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