Miller Megan M, Williams Amy E, Scott Eric L, Trost Zina, Hirsh Adam T
Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana.
Department of Psychiatry, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana.
J Pain. 2022 Feb;23(2):212-222. doi: 10.1016/j.jpain.2021.07.005. Epub 2021 Aug 8.
Mechanisms explaining the relationship between pain-related injustice appraisals and functional outcomes in youth with chronic pain have yet to be examined. In studies of adults, greater pain-related injustice is associated with worse depressive symptoms and greater pain through greater anger. No study to date has examined anger expression as a mediator in the relationships between pain-related injustice appraisals and physical and psychosocial functioning in youth with chronic pain. The current sample consisted of 385 youth with varied pain conditions (75% female, 88% White, M=14.4 years) presenting to a university-affiliated pain clinic. Patients completed self-report measures assessing anger expression (anger-out and anger-in), pain-related injustice, pain intensity, functional disability, and emotional, social, and school functioning. Bootstrapped mediation analyses indicated that only anger-out (indirect effect= -.12, 95% CI: -.21, -.05) mediated the relationship between pain-related injustice and emotional functioning, whereas both anger-out (indirect effect= -.17, 95% CI: -.27, -.09) and anger-in (indirect effect= -.13, 95% CI: -.09, -.001) mediated the relationship between pain-related injustice and social functioning. Neither mode of anger expression mediated the relationship between pain-related injustice and pain intensity, functional disability, or school functioning. Collectively, these findings implicate anger as one mechanism by which pain-related injustice impacts psychosocial outcomes for youth with chronic pain. PERSPECTIVE: Anger expression plays a mediating role in the relationship between pain-related injustice appraisals and psychosocial outcomes for youth with chronic pain. Anger represents one target for clinical care to decrease the deleterious impact of pain-related injustice on emotional and social functioning.
解释慢性疼痛青少年中与疼痛相关的不公正评价和功能结果之间关系的机制尚未得到研究。在针对成年人的研究中，与疼痛相关的不公正感越强，抑郁症状越严重，愤怒情绪也会加剧疼痛。迄今为止，尚无研究将愤怒表达作为慢性疼痛青少年中与疼痛相关的不公正评价和身体及心理社会功能之间关系的中介因素进行考察。本研究样本包括385名患有不同疼痛病症的青少年（75%为女性，88%为白人，平均年龄14.4岁），他们前往一家大学附属疼痛诊所就诊。患者完成了自我报告测量，评估愤怒表达（愤怒外向和愤怒内向）、与疼痛相关的不公正感、疼痛强度、功能残疾以及情绪、社交和学校功能。自抽样中介分析表明，只有愤怒外向（间接效应=-0.12，95%置信区间：-0.21，-0.05）在与疼痛相关的不公正感和情绪功能之间起中介作用，而愤怒外向（间接效应=-0.17，95%置信区间：-0.27，-0.09）和愤怒内向（间接效应=-0.13，95%置信区间：-0.09，-0.001）均在与疼痛相关的不公正感和社交功能之间起中介作用。愤怒表达的两种模式均未在与疼痛相关的不公正感和疼痛强度、功能残疾或学校功能之间起中介作用。总体而言，这些发现表明愤怒是与疼痛相关的不公正感影响慢性疼痛青少年心理社会结果的一种机制。观点：愤怒表达在慢性疼痛青少年中与疼痛相关的不公正评价和心理社会结果之间的关系中起中介作用。愤怒是临床护理的一个目标，可减少与疼痛相关的不公正感对情绪和社交功能的有害影响。
