Abstract
Self-efficacy has been consistently found to be a protective factor against psychological distress and disorders in the literature. However, little research is done on the moderating effect of self-efficacy on depressive symptoms in the context of chronic pain. This cross-sectional study aimed to examine if pain self-efficacy attenuated the direct relationship between pain intensity and depressive symptoms, as well as their indirect relationship through reducing the extent of catastrophizing when feeling pain (moderated mediation). 664 community-dwelling Chinese older adults aged 60–95 years who reported chronic pain for at least three months were recruited from social centers. They completed a battery of questionnaires on chronic pain, pain self-efficacy, catastrophizing, and depressive symptoms in individual face-to-face interviews. Controlling for age, gender, education, self-rated health, number of chronic diseases, pain disability, and pain self-efficacy, pain catastrophizing was found to partially mediate the connection between pain intensity and depressive symptoms. Furthermore, the relationship between pain intensity and depressive symptoms was moderated by pain self-efficacy. Self-efficacy was also found to moderate the relationship between pain intensity and catastrophizing and the moderated mediation effect was confirmed using bootstrap analysis. The results suggested that with increasing levels of self-efficacy, pain intensity’s direct effect on depressive symptoms and its indirect effect on depressive symptoms via catastrophizing were both reduced in a dose-dependent manner. Our findings suggest that pain self-efficacy is a significant protective factor that contributes to psychological resilience in chronic pain patients by attenuating the relationship of pain intensity to both catastrophizing and depressive symptoms.
Highlights
Chronic pain can be a debilitating condition and is common among older adults
Catastrophic cognition had a highly positive correlation with depressive symptoms (r = 0.66, p
The direct effect of pain intensity on depressive symptoms in our study suggests that chronic pain itself appears to be a sufficient condition for the development of depression in older adults
Summary
Chronic pain can be a debilitating condition and is common among older adults. Some estimates suggest that half or more of community-dwelling older adults and up to 80% of nursing home residents suffer from chronic pain [1]. We articulate a new cognitive model of pain and depression and tested it in a community sample of Chinese older adults in Hong Kong, the model may be applicable to younger persons with chronic pain as well. In this model, self-efficacy and catastrophizing play a moderational and a mediational role respectively in the connection between pain and depression. Self-efficacy and catastrophizing play a moderational and a mediational role respectively in the connection between pain and depression What distinguishes this model from the others in the existing literature is how these factors are put together in an integrated model
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