Background & Aims
Chronic and loneliness are common prevalent problems among adults1,2. Both can have a profound impact on individuals’ quality of life, physical and mental well-being, and overall functioning. For instance, loneliness and pain are positively associated3,4, however the temporal relationship between them is uncertain. A recent longitudinal study pointed to a bi-directional relationship indicating that the mechanisms underlying these processes may differ5. Moreover, both pain and loneliness have been strongly associated with mental health difficulties6–8. There is a dearth of literature studying the mediation effect of combined depression, stress, and anxiety in the relationship between loneliness and pain outcomes9. Therefore, the present study aim is twofold: (1) to explore the direct effect of loneliness on pain-related outcomes (interference and intensity) and (2) to examine whether depression, anxiety and stress mediate the relationship between loneliness and pain-related outcomes.
Methods
The study sample was composed of 335 adults with chronic pain (M = 24.46, SD = 8.97). The sample was predominantly female (68.7%). The instruments used to measure the study variables, namely depression, loneliness, pain interference and intensity encompassed the UCLA loneliness scale, the DASS-21 (Depression, Anxiety and Stress Scales), the Brief Pain Interference (BPI), and the Numeric Rating Scale (NRS-11). Participants completed a 20-minute questionnaire composed of two sections. First section included the upper mentioned instruments, followed by the second section reporting data on sociodemographics (age, sex, course schedule, marital status) and on pain outcomes (pain intensity, interference, duration, and frequency). To determine mediation, bootstrapping (5000 samples) was performed using the PROCESS model (version 29., SPSS)10. To-sided bias-corrected 95% CI were constructed to evaluate the indirect effect.
Results
The bootstrap result for indirect effect of depression (?= .17, p< .05) was significant, indicating that depression mediated the relationship between loneliness and pain interference. The same structure was followed for anxiety and stress as mediators, which resulted in signficant mediation, respectively (?= .28, p< .001; ?= .32, p< .001). Moreover, the mediation of depression, anxiety and stress was also significant in the relationhip between loneliness and pain intensity, respectively (?= .03, p< .01; ?= .03, p< .001; ?= .02, p< .01). Therefore, mental health issues, such as depressive symtpoms, anxiety and stress, played a full mediation role in the relationship between loneliness and pain outcomes (interference and intensity).
Conclusions
To best of our knowledge this is the first study to simultaneously introduce the aforementioned variables in the same model to study the mediation role of mental health between loneliness and pain outcomes. Literature framework in chronic pain is still a novel area of research in Portugal, therefore, the present study raises awareness on the impact of mental health among adults with chronic pain. This study advances our understanding on the importance of mental health while providing empirical data on the mediation effect of depressive symptoms, anxiety, and stress among adults.
References
1.Cohen, S. P., Vase, L., & Hooten, W. M. (2021). Chronic Pain 1 Chronic pain: an update on burden, best practices, and new advances. Www.Thelancet.Com, 397. https://doi.org/10.1016/S0140-6736(21)00393-7
2.Emerson, K., Boggero, I., Ostir, G., & Jayawardhana, J. (2017). Pain as a Risk Factor for Loneliness Among Older Adults. Https://Doi.Org/10.1177/0898264317721348, 30(9), 1450–1461. https://doi.org/10.1177/0898264317721348
3.Jaremka, L. M., Fagundes, C. P., Glaser, R., Bennett, J. M., Malarkey, W. B., & Kiecolt-Glaser, J. K. (n.d.). Loneliness predicts pain, depression, and fatigue: Understanding the role of immune dysregulation. https://doi.org/10.1016/j.psyneuen.2012.11.016
4.Lim, M. H., Eres, R., & Vasan, S. (2020). Understanding loneliness in the twenty-first century: an update on correlates, risk factors, and potential solutions. Social Psychiatry and Psychiatric Epidemiology, 55, 793–810. https://doi.org/10.1007/s00127-020-01889-7
5.Loeffler, A., & Steptoe, A. (2020). Bidirectional longitudinal associations between loneliness and pain, and the role of inflammation. https://doi.org/10.1097/j.pain.0000000000002082
6.Mann, F., Wang, J., Pearce, E., Ma, R., Schlief, M., Lloyd-Evans, B., Ikhtabi, S., & Johnson, S. (2022). Loneliness and the onset of new mental health problems in the general population. Social Psychiatry and Psychiatric Epidemiology, 57(11), 2161–2178. https://doi.org/10.1007/S00127-022-02261-7/FIGURES/2
7.Pinton, A., Wroblewski, K., Schumm, L. P., Hawkley, L. C., & Huisingh-Scheetz, M. (2023). Relating depression, anxiety, stress and loneliness to 5-year decline in physical function and frailty. Archives of. Archives of Gerontology and Geriatrics, 115, 105199. https://doi.org/10.1016/j.archger.2023.105199
8.Victor, C. R., & Yang, K. (2012). The prevalence of loneliness among adults: A case study of the United Kingdom. Journal of Psychology: Interdisciplinary and Applied, 146(1–2), 85–104. https://doi.org/10.1080/00223980.2011.613875
9.Wolters, N. E., Mobach, L., Wuthrich, V. M., Vonk, P., Van der Heijde, C. M., Wiers, R. W., Rapee, R. M., & Klein, A. M. (2023). Emotional and social loneliness and their unique links with social isolation, depression and anxiety. Journal of Affective Disorders, 329(February), 207–217. https://doi.org/10.1016/j.jad.2023.02.096
10.Hayes, A.F. (2022). The process macro for SPSS, SAS, and R. available at: ttps://processmacro.org/ index.html.
Presenting Author
Catarina Tomé-Pires
Poster Authors
Catarina Tomé Pires
PhD
CEU-Coop. Ensino Universitário, CRL (VAT PT501641238) / Universidade Autónoma de Lisboa
Lead Author
Genta Kulari
Autonomous University of Lisbon
Lead Author
Luísa Ribeiro
Autonomous University of Lisbon
Lead Author
Tito Laneiro
Autonomous University of Lisbon
Lead Author
Topics
- Mechanisms: Psychosocial and Biopsychosocial