title: Pain and symptoms of depression in older adults living in community and in nursing homes: the role of activity restriction as a potential mediator and moderator.
abstract: BACKGROUND
  Chronic pain is likely to lead to depressive symptoms, but the nature of this relationship is not completely clear. The aim of the present study is to analyze the role of activity restriction in the pain-depression relationship in older people, and to test the hypothesis that this role is more relevant in community-dwelling older people than in nursing home residents.
  
  
  METHODS
  Depressive symptoms, pain intensity, and activity restriction were measured in a sample of 208 older adults with osteoarthritis, 102 living in nursing homes (NH), and 106 in the community. Analyses were carried out using moderation and moderated mediation analyses approach, treating activity restriction as a confounder.
  
  
  RESULTS
  RESULTS showed a significant confounding effect of activity restriction, interaction effect between pain intensity and activity restriction on depression, and modifying effect of pain intensity on depression by adding activity restriction into the model. These results suggest a potential mediating and moderating effects of activity restriction. Moreover, analyses suggest that, surprisingly, the strength of the mediation could be higher in nursing homes.
  
  
  CONCLUSIONS
  Overall, it may be that what is really important to emotional well-being is not so much pain itself, but rather the way in which the pain alters older people's lives. The greater strength of the mediation in NH might be understood within the scope of self-determination theory. Generally speaking, the NH context has been considered as a coercive setting, promoting non-autonomous orientation. In this context, when events are objectively coercive, people may lack perceived autonomy and hence be at greater risk of depression.
authors: Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors: Almudena
authors: A
authors: López-Lopez
authors: Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors: José L
authors: JL
authors: González
authors: Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors: Miriam
authors: M
authors: Alonso-Fernández
authors: Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors: Noelia
authors: N
authors: Cuidad
authors: Department of Psychology, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
authors: Borja
authors: B
authors: Matías
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D059350:Chronic Pain / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D003863:Depression / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D057187:Independent Living / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D009735:Nursing Homes / Q000706:statistics & numerical data*; D010003:Osteoarthritis / Q000523:psychology; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors