[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].
BACKGROUND
Chronic pain and depression are highly comorbid; however, the longitudinal link is only partially understood. This study examined direct and indirect effects of chronic back pain on depression using path analysis in a general population sample, focussing on cognitive mediator variables.


METHODS
Analyses are based on 413 participants (aged 18-75 years) in a population-based postal survey on back pain who reported chronic back pain at baseline. Follow-up data were collected after 1 year. Depression was measured with the Center for Epidemiologic Studies Depression Scale (CES-D). Fear-avoidance-beliefs (FABQ), catastrophizing and helplessness/hopelessness (KRSS) were considered as cognitive mediators. Data were analyzed using path analysis.


RESULTS
Chronic back pain had no direct effect on depression at follow-up when controlling for cognitive mediators. A mediating effect emerged for helplessness/hopelessness but not for catastrophizing or fear-avoidance beliefs.


CONCLUSIONS
These results support the cognitive mediation hypothesis which assumes that psychological variables mediate the association between pain and depression. The importance of helplessness/hopelessness is of relevance for the treatment of patients with chronic back pain.
Institut für Community Medicine, Universität Greifswald, Walther-Rathenau-Str. 48, 17487, Greifswald, Deutschland.
R A
RA
Fahland
T
T
Kohlmann
M
M
Hasenbring
Y-S
YS
Feng
C O
CO
Schmidt
D000293:Adolescent; D000328:Adult; D000368:Aged; D001416:Back Pain / Q000523:psychology*; D058443:Catastrophization; D003469:Culture; D003866:Depressive Disorder / Q000523:psychology*; D005239:Fear; D005260:Female; D006380:Helplessness, Learned; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011795:Surveys and Questionnaires; D055815:Young Adult