Wilson Jenna M, Colebaugh Carin A, Meints Samantha M, Flowers K Mikayla, Edwards Robert R, Schreiber Kristin L
Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, USA.
J Pain Res. 2022 Sep 16;15:2939-2948. doi: 10.2147/JPR.S377789. eCollection 2022.
Loneliness increased during the COVID-19 pandemic and social distancing guidelines, potentially exacerbating negative cognitions about pain. The present study investigated the longitudinal relationship between loneliness, assessed during the early weeks of the pandemic, and pain catastrophizing, assessed after living in the pandemic for approximately 1 year, among chronic pain patients. We also examined whether severity of depressive symptoms mediated this association.
This prospective longitudinal study recruited individuals with chronic pain (N=93) from Massachusetts using an online convenience sampling method via the platform Rally. Participants completed an initial survey early after the onset of social distancing (4/28/20-6/17/20; Time 1) and a follow-up survey 1 year later (5/21/21-6/7/21; Time 2). Participants completed validated assessments of loneliness (T1), pain catastrophizing (T2), and depression (T2). Spearman correlations and Mann-Whitney -tests were used to explore associations among psychosocial, pain, and participant characteristics. A mediation analysis was conducted to test whether the association between loneliness and pain catastrophizing was mediated by depression.
Participants had a mean age of 40.6 years and were majority female (80%) and White (82%). Greater loneliness was associated with subsequent higher pain catastrophizing (=1.23, 95% CI [0.03, 2.44]). Mediation analysis showed a significant indirect effect (=0.57, 95% CI [0.10, 1.18) of loneliness (T1) on catastrophizing (T2) through depression (T2) while accounting for several important covariates. The direct effect of loneliness on catastrophizing was no longer significant when depression was included in the model (=0.66, 95% CI [-0.54, 1.87]).
Findings suggest that greater loneliness during the pandemic was associated with higher pain catastrophizing 1 year later, and severity of depression after living in the pandemic mediated this association. As loneliness, depression, and catastrophizing can all be modified with behavioral interventions, understanding the temporal associations among these variables is important for the employment of future empirically supported treatments.
在新冠疫情和社交距离指导措施期间，孤独感有所增加，这可能会加剧对疼痛的负面认知。本研究调查了疫情初期评估的孤独感与慢性疼痛患者在经历疫情约1年后评估的疼痛灾难化之间的纵向关系。我们还研究了抑郁症状的严重程度是否介导了这种关联。
这项前瞻性纵向研究通过Rally平台采用在线便利抽样方法，从马萨诸塞州招募了慢性疼痛患者（N = 93）。参与者在社交距离措施开始后不久（2020年4月28日至6月17日；时间1）完成了初始调查，并在1年后（2021年5月21日至6月7日；时间2）完成了随访调查。参与者完成了孤独感（时间1）、疼痛灾难化（时间2）和抑郁（时间2）的有效评估。使用斯皮尔曼相关性分析和曼-惠特尼检验来探索心理社会、疼痛和参与者特征之间的关联。进行中介分析以检验孤独感与疼痛灾难化之间的关联是否由抑郁介导。
参与者的平均年龄为40.6岁，大多数为女性（80%），白人（82%）。更高的孤独感与随后更高的疼痛灾难化相关（β = 1.23，95%可信区间[0.03, 2.44]）。中介分析显示，在考虑几个重要协变量的情况下，孤独感（时间1）通过抑郁（时间2）对灾难化（时间2）有显著的间接效应（β = 0.57，95%可信区间[0.10, 1.18]）。当模型中纳入抑郁时，孤独感对灾难化的直接效应不再显著（β = 0.66，95%可信区间[-0.54, 1.87]）。
研究结果表明，疫情期间更高的孤独感与1年后更高的疼痛灾难化相关，并且在经历疫情后的抑郁严重程度介导了这种关联。由于孤独感、抑郁和灾难化都可以通过行为干预来改善，了解这些变量之间的时间关联对于采用未来经实证支持的治疗方法很重要。
