Edwards Robert R, Goble Layne, Kwan Amy, Kudel Ian, McGuire Lynanne, Heinberg Leslie, Wigley Fred, Haythornthwaite Jennifer
Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA.
Clin J Pain. 2006 Sep;22(7):639-46. doi: 10.1097/01.ajp.0000210918.26159.94.
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.
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.
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.
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.
低教育程度与众多不良健康结果相关，一些证据表明心理社会变量可能介导教育的影响。此外，心理社会功能与健康相关结果之间的关系可能受到教育水平的调节，正规教育程度较低的个体更容易受到负面认知和情感状态的有害影响。本研究旨在描述教育水平与疼痛灾难化之间的这种相互关系。
我们调查了自我报告的教育水平与疼痛和社会残疾之间的关联，评估了灾难化在这些关联中的潜在中介作用，并且我们还在硬皮病（一种经常疼痛的自身免疫性疾病）患者样本中研究了教育作为灾难化对疼痛和社会残疾影响的调节因素。
首先，疼痛报告中与教育相关的差异可由灾难化和抑郁来解释。其次，在控制了人口统计学因素、疾病严重程度和抑郁症状后，教育调节了灾难化、疼痛情感和社会功能之间的关系。具体而言，在正规教育程度较低的人群中，灾难化与更多的情感性疼痛报告高度相关。此外，在正规教育程度较低的个体中，灾难化与社会功能障碍呈负相关。
总体而言，研究结果支持教育与疼痛相关认知/情感功能之间相互作用的多种模型，尽管在中介分析和调节分析中，较低的正规教育水平都是不良疼痛相关结果的危险因素。
