Pain-related anxiety mediates the relationship between depressive symptoms and pain interference in veterans with hepatitis C.
OBJECTIVE
Depression and chronic pain are common in persons chronically infected with the hepatitis C virus (HCV), although little is known about the rate of co-occurrence or mechanisms by which they are associated. We evaluated whether pain-related anxiety mediates the relationship between depressive symptoms and pain-related physical functioning in patients with HCV.


METHODS
Patients with HCV (n=175) completed self-report measures assessing demographic characteristics, pain-related function and mental health. Path analyses examined direct effects of cognitive-affective and somatic symptoms of depression on pain interference and indirect effects of these relationships via four subscales of the Pain Anxiety Symptoms Scale-20.


RESULTS
Cognitive-affective and somatic symptoms of depression were positively and significantly related to pain interference. Pain-related anxiety mediated the relationship between both cognitive-affective and somatic symptoms of depression, and this mediation was predominantly accounted for by the escape-avoidance component of pain-related anxiety.


CONCLUSIONS
Findings indicate a potential mediating role of pain-related anxiety, particularly escape-avoidance anxiety, on the relationship between depression and pain interference in patients with HCV. These findings suggest that escape-avoidance anxiety may be a particularly germane target for treatment in patients with HCV and chronic pain, particularly when depression, with characteristic features of withdrawal and inhibition, is a comorbid condition.
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
Melissa H
MH
Adams
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
Travis I
TI
Lovejoy
Department of Anesthesiology and Pain Medicine and Center for Pain Research on Impact, Measurement, & Effectiveness, University of Washington, Seattle, WA, USA.
Dennis C
DC
Turk
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA.
Steven K
SK
Dobscha
VISN 22 Network Office and Division of Mental Health, Long Beach VA Medical Center, Long Beach, CA, USA; Department of Psychiatry, University of California San Diego & Department of Psychiatry and Human Behavior, University of California-Irvine, Irvine, CA, USA.
Peter
P
Hauser
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA; Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA. Electronic address: benjamin.morasco@va.gov.
Benjamin J
BJ
Morasco
D001007:Anxiety / Q000150:complications; D059350:Chronic Pain / Q000523:psychology*; D003863:Depression / Q000503:physiopathology*; D005260:Female; D019698:Hepatitis C, Chronic / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015205:Northwestern United States; D016016:Proportional Hazards Models; D057566:Self Report; D014728:Veterans / Q000523:psychology*
Chronic pain; Comorbidity; Depression; Hepatitis C virus; Pain-related anxiety