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Distinct social pathways in the links between pain interference and psychological function in youth with chronic pain
Juan P Sanabria-Mazo1,2, Josep Roman-Juan3, Mark P Jensen4
1Unit for the Study and Treatment of Pain-ALGOS, Department of Psychology, Research Center for Behavior Assessment (CRAMC), Universitat Rovira i Virgili, Tarragona, Spain.
Abstract:
Evidence suggests that pain interference is linked to depression and anxiety in youth with chronic pain, yet the contributions of the social environment to these associations remain unclear. Guided by the Stress-Buffering Model of Social Support, this study tested theory-driven mediation and moderation models to examine whether peer relationships and bullying contribute to or modify concurrent and short-term longitudinal associations between pain interference and psychological function. A cross-sectional sample of 744 youth with chronic pain from the EPIDOL project (61% girls; mean age = 11.9 years, SD = 2.6) completed measures of pain characteristics, pain interference, peer relationship quality, bullying, and psychological function (depressive and anxiety symptoms). A short-term longitudinal subsample of 357 youth who reported chronic pain 12 months later completed measures at both assessments. Peer relationships significantly mediated the association between pain interference and depressive symptoms in both samples. No mediating effects were observed for anxiety symptoms or for being bullied. In the cross-sectional sample, being bullied in the past significantly moderated the association between pain interference and depressive symptoms; in the longitudinal sample, this effect was moderated by peer relationship quality. For anxiety, only concurrent moderation was observed, with past bullying amplifying its association with pain interference. These findings extend theoretical models by demonstrating that supportive and adverse peer experiences influence psychological adjustment through distinct contextual pathways. They highlight the importance of assessing the social environment in clinical evaluations and suggest that strengthening peer support may be a valuable target for intervention in youth with chronic pain.
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