title: Catastrophizing, pain, and social adjustment in scleroderma: relationships with educational level.
abstract: OBJECTIVE
  Low educational attainment is related to numerous adverse health outcomes, and some evidence suggests that psychosocial variables may mediate education's effects. Moreover, the relationship between psychosocial functioning and health-related outcomes may be moderated by educational level, with individuals lower in formal education being more susceptible to the deleterious effects of negative cognitive and affective states. The present study sought to characterize such interrelationships between educational level and pain-related catastrophizing.
  
  
  METHODS
  We investigated the association of self-reported educational level with pain and social disability, we evaluated catastrophizing's potential mediating role in those associations, and we also investigated education as a moderator of catastrophizing's effects on pain and social disability in a sample of patients with scleroderma, a frequently painful autoimmune disorder.
  
  
  RESULTS
  First, education-related differences in pain report were accounted for by catastrophizing and depression. Second, after controlling for demographic factors, disease severity, and depressive symptoms, education moderated the relationship between catastrophizing, pain affect, and social function. Specifically, catastrophizing was more highly associated with greater reporting of affective pain among those with less formal education. In addition, catastrophizing inversely correlated with social disruption among individuals with less formal education.
  
  
  CONCLUSIONS
  Collectively, study findings support multiple models of interaction between education and pain-related cognitive/affective functioning, though in both mediational and moderational analyses, lower levels of formal education act as a risk factor for adverse pain-related outcomes.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA. redwar10@jhmi.edu
authors.forename: Robert R
authors.initials: RR
authors.lastname: Edwards
authors.forename: Layne
authors.initials: L
authors.lastname: Goble
authors.forename: Amy
authors.initials: A
authors.lastname: Kwan
authors.forename: Ian
authors.initials: I
authors.lastname: Kudel
authors.forename: Lynanne
authors.initials: L
authors.lastname: McGuire
authors.forename: Leslie
authors.initials: L
authors.lastname: Heinberg
authors.forename: Fred
authors.initials: F
authors.lastname: Wigley
authors.forename: Jennifer
authors.initials: J
authors.lastname: Haythornthwaite
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000453:epidemiology*; D015897:Comorbidity; D004522:Educational Status; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012595:Scleroderma, Systemic / Q000453:epidemiology*; D012917:Social Adjustment; D012920:Social Behavior Disorders / Q000453:epidemiology*; D013223:Statistics as Topic; D011795:Surveys and Questionnaires