Background: Pain is a pervasive and disabling barrier for the injured athlete threatening his/her ability to participate in sporting events and professional goals. However, psychological factors in the treatment process of chronic diseases are an important factor in involving the patient in treatment and making treatment decisions. Objectives: This research aimed to investigate the relationship between emotion regulation and pain self-efficacy with psychosocial adjustment in athletes with chronic pain, considering the mediating role of mental fatigue. Methods: The statistical population of this descriptive correlational study was all athletes with chronic pain referred to the Iranian Sports Medicine Federation. Using the convenience sampling method, a total of 200 injured athletes were selected as the sample size. For data collection, Psychosocial Adjustment to Illness Scale (PAIS), Pain Self-efficacy Questionnaire (PSEQ), Pain Fatigue Scale (PFS), and Cognitive Emotion Regulation Questionnaire (CERQ-short) were used. Descriptive statistics, correlation matrix, and path analysis (structural model) were used to analyze data. Also, SPSS (v21) and AMOS (v23) software were used to analyze the data. Results: According to the results, pain self-efficacy (β = 0.18), adaptive emotion regulation (β = 0.27), and mental fatigue (β = -0.19) had a direct positive and significant impact on psychosocial adjustment. Also, the direct effect of pain self-efficacy (β = -0.19), maladaptive emotion regulation (β = 0.17), and adaptive emotion regulation (β = -0.12) on mental fatigue was significant. In addition, the indirect effect of pain self-efficacy and maladaptive emotions on psychosocial adjustment via mental fatigue was significant. Conclusions: Mental fatigue plays a good mediating role between pain self-efficacy and emotion regulation with psychosocial adjustment of athletes with chronic pain.
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