Understanding the Relationship Between Spiritual Well-Being and Depression in Chronic Pain Patients: The Mediating Role of Pain Catastrophizing.

BACKGROUND: It is well established that there is an association between chronic pain and depression. AIMS: The present study aimed to identify whether pain catastrophizing and spiritual well-being may influence depression in chronic pain patients when other variables are controlled for (sociodemographic characteristics and pain intensity). Furthermore, it investigated possible mechanisms by which spiritual well-being can influence depression in these patients. DESIGN: The present study employed a cross-sectional design. SETTINGS AND PARTICIPANTS: This study was performed with a convenience sample of 300 consecutive patients with different types of chronic pain (defined as recurrent or persistent pain over >3 months), referred to clinics affiliated with Shiraz university of Medical Sciences between March and October 2017. METHODS: Patients completed validated self-report questionnaires: Spiritual Well-being Questionnaire, Patient Health Questionnaire, Pain Catastrophizing Scale, and Numeric Rating Scale. RESULTS: Hierarchical multiple regression analysis indicated that a significant portion of the variance in depression scores can be explained by catastrophizing and spiritual well-being. In Multiple Mediation Procedure, pain catastrophizing could negatively mediate the relationship between spiritual well-being and depression when controlling for sociodemographic characteristics and pain intensity. CONCLUSIONS: The findings add some evidence to further support the influence of spiritual well-being on depression levels through diminished pain catastrophizing. The present results could help clinicians to determine which variables should be emphasized for a successful treatment of depression in pain patients. Clinical interventions that increase meaningfulness and purpose in life may allow patients with chronic pain to overcome the maladaptive cognitions associated with pain, thereby reducing depressive symptoms.