The contribution of family cohesion and the pain-coping process to depressive symptoms in fibromyalgia.

This research evaluated a model for examining the role of family cohesion and the pain-coping process in predicting depressive symptoms in fibromyalgia, a chronic pain disorder of unknown etiology. Depressive symptoms were highly prevalent in this patient group. Fifty-nine percent of the sample met or exceeded the cutoff score of 16 for depression on the Center for Epidemiological Studies Depression Scale (CES-D), while slightly greater than 50% exceeded the cutoff score of 19, a figure that is suggested for evaluating depression in chronic pain populations. Multiple regression analyses, controlling for demographic factors and medication use, revealed that low family cohesion (either reported by the patient or the patient's spouse), high pain, high helplessness, and high passive coping contributed independently to greater CES-D scores. Pain also was related to higher depression scores indirectly through its association with greater helplessness and passive coping. In contrast, no indirect effects of family cohesion were found on depressive symptoms through pain, helplessness, and passive coping. Structural equation modeling procedures provided confirmatory evidence of the significance of these relationships, indicating a high degree of goodness-of-fit with the model examined. The data illustrate the import of a multidimensionalframeworkfor conceptualizing physical, psychological, and social determinants of depressive disturbance in fibromyalgia.