Depression and Cancer Pain: Mediating Roles of Anxiety and Pain Beliefs

The psychological mechanisms linking depression and pain in cancer remain unclear despite consistent evidence of their strong association.

To investigate psychological pathways underlying the relationship between depression and pain, mediated by anxiety and pain-related beliefs.

The participants were 140 adults with a confirmed cancer diagnosis, recruited from three university hospitals in South Korea between April 2024 and May 2025. Participants completed self-report questionnaires, including the M. D. Anderson Symptom Inventory, Hospital Anxiety and Depression Scale, and the Pain Beliefs and Perceptions Inventory.

A serial-parallel mediation analysis revealed no significant direct effects of depression on pain severity. However, a significant indirect effect was observed through anxiety and the belief that pain is persistent (Time) (b = 0.101, 95% CI [0.032, 0.185]). This pathway differed significantly from other indirect effects. Higher depression levels were associated with greater anxiety, which, in turn, was associated with a stronger belief that pain is persistent, and ultimately, with higher pain severity.

Depression may indirectly contribute to greater pain severity in patients with cancer patients through anxiety and the belief that pain is persistent. These findings underscore the need to address emotional distress and maladaptive pain beliefs in the psychological management of cancer-related pain.