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Depression determines illness conviction and pain impact: a structural equation modeling analysis
P J Davis1, J L Reeves, B A Hastie
1Alliant University-Fresno, Los Angeles, CA, USA.
Pain Medicine (Malden, Mass.)
|April 23, 2004
Summary
Depression significantly impacts illness conviction and pain perception in headache and orofacial pain patients. Targeting depression is crucial for effective pain management, regardless of the specific pain diagnosis.
Area of Science:
- Psychology and Neuroscience
- Pain Medicine
- Psychometric Analysis
Background:
- Headache and orofacial pain conditions are complex, involving behavioral and psychological factors.
- Understanding the interplay of psychological functioning in distinct pain categories is essential for targeted treatment.
Purpose of the Study:
- To develop an algorithm using factor analysis and structural equation modeling (SEM) to describe behavioral and psychological functioning in pain patients.
- To investigate if the factor structure differs across myofascial, neuropathic, and neurovascular pain categories.
Main Methods:
- Utilized the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Multidimensional Pain Inventory (MPI), Beck Depression Inventory-II (BDI-II), and visual analog scale for functional limitation (VAS-FL).
- Employed Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) via SEM on a split-sample design (N=390).
- Used Analysis of Variance (ANOVA) to compare demographic variables and factor structures across diagnostic groups.
Main Results:
- EFA identified a three-factor solution: Depression, Illness Conviction, and Pain Impact.
- CFA/SEM confirmed this structure and revealed Depression as a critical causal factor influencing Illness Conviction and Pain Impact.
- No significant causal relationship was found between Illness Conviction and Pain Impact; demographic and diagnostic group analyses showed no significant differences.
Conclusions:
- A robust three-factor model (Depression, Illness Conviction, Pain Impact) was validated for headache and orofacial pain patients.
- Depression emerged as a key determinant of illness conviction and pain impact, highlighting it as a primary treatment target.
- The similar psychological factor structure across myofascial, neuropathic, and neurovascular pain suggests shared psychological mechanisms despite differing pathophysiology, underscoring SEM's utility in pain research.