Abstract
Pain intensity and symptoms of depression are correlated and individually associated with decreased physical function. We compared two explanatory mediation models; one with depression as mediator of the association of pain intensity with physical function and the other one with pain intensity as the mediator of the effect of depression on physical function. In a cross-sectional study, 102 patients with upper extremity musculoskeletal illness completed measures of pain intensity, PROMIS depression CAT, PROMIS physical function-upper extremity CAT and demographics. We determined that pain intensity and symptoms of depression were partial mediators of their respective and independent effects on physical function. While depression had a larger standardized mediation effect and a bigger kappa-squared (κ 2) effect size compared to pain intensity, the actual proportion of variance in physical function that could be explained by the mediated effects (i.e., R 2 mediation effect size) was equal in both models suggesting that the two mediation models have equal ability to explain variations in physical function. The bidirectional mediation effect suggests a reinforcement mechanism, in which, pain intensity and symptoms of depression reciprocally influence their negative impacts on physical function among patients with musculoskeletal illness.
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Mojtaba Talaei-Khoei, Stefan F. Fischerauer, Ragini Jha, David Ring, Neal Chen, and Ana-Maria Vranceanu declare that they have no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors. Informed consent was obtained from all patients for being included in the study.
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Talaei-Khoei, M., Fischerauer, S.F., Jha, R. et al. Bidirectional mediation of depression and pain intensity on their associations with upper extremity physical function. J Behav Med 41, 309–317 (2018). https://doi.org/10.1007/s10865-017-9891-6
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DOI: https://doi.org/10.1007/s10865-017-9891-6