Optimism and depression: a new look at social support as a mediator among women at risk for breast cancer.

OBJECTIVE: Breast cancer risk is a chronic stressor associated with depression. Optimism is associated with lower levels of depression among breast cancer survivors. However, to our knowledge, no studies have explored the relationship between optimism and depression among women at risk for breast cancer. We hypothesized that women at risk for breast cancer who have higher levels of optimism would report lower levels of depression and that social support would mediate this relationship. METHOD: Participants (N = 199) with elevated distress were recruited from the community and completed self-report measures of depression, optimism, and social support. Participants were grouped based on their family history of breast cancer. Path analysis was used to examine the cross-sectional relationship between optimism, social support, and depressive symptoms in each group. RESULTS: Results indicated that the variance in depressive symptoms was partially explained through direct paths from optimism and social support among women with a family history of breast cancer. The indirect path from optimism to depressive symptoms via social support was significant (ß = -.053; 90% CI = -.099 to -.011, p = .037) in this group. However, among individuals without a family history of breast cancer, the indirect path from optimism to depressive symptoms via social support was not significant. CONCLUSIONS: These results suggest that social support partially mediates the relationship between optimism and depression among women at risk for breast cancer. Social support may be an important intervention target to reduce depression among women at risk for breast cancer.

Pain self-efficacy mediates the relationship between depressive symptoms and pain severity.

OBJECTIVES: We examined the relationships between depressive symptoms, pain severity, and pain self-efficacy (PSE) in patients with chronic low back pain (CLBP). We hypothesized that change in depressive symptoms would significantly influence change in pain severity, and that PSE indirectly affects this relationship. MATERIALS AND METHODS: Participants were 109 CLBP patients in a 4-week multidisciplinary rehabilitation program for CLBP. They completed measures of PSE, depression, and pain severity at admission and discharge. Structural equation modeling was used to test the significant direct and indirect effects from pretreatment to posttreatment. RESULTS: Change in depressive symptoms significantly predicted change in pain severity in affective (ß=0.358; 95% confidence interval [CI], 0.206-0.480; P=0.006), sensory (ß=0.384; 95% CI, 0.257-0.523; P=0.002), and evaluative pain (ß=0.456; 95% CI, 0.285-0.605; P=0.002). The indirect effects of change in PSE partially accounted for the relationship between change in depressive symptoms and change in sensory (ß=0.105; 95% CI, 0.016-0.241; P=0.023) and evaluative pain (ß=0.121; 95% CI, 0.010-0.249; P=0.040). The relationship between change in depressive symptoms and change in affective pain was fully accounted for by the indirect effect of change in PSE (ß=0.203; 95% CI, 0.082-0.337; P=0.002). DISCUSSION: These findings suggest that pain management and rehabilitation programs for CLBP should specifically target PSE as a key aspect of treatment.

Biopsychosocial functioning and pain self-efficacy in chronic low back pain patients.

The aim of this study was to examine the relationship between biopsychosocial functioning and pain severity and to evaluate whether pain self-efficacy (PSE) mediates this relationship. This study used archival data from a multidisciplinary pain management program. Participants were 99 individuals (69% female) with chronic low back pain who completed measures of biological, psychological, and social functioning, pain severity, and PSE at admission. They ranged in age from 18 to 72 yr (mean = 42.6, standard deviation = 12.1). Structural equation modeling and bootstrapping techniques were used to test the significance of the mediated model. As we predicted, lower biological functioning (beta = -0.011; 95% confidence interval [CI] = -0.019 to -0.004, p = 0.002) and social functioning (beta = -0.009; 95% CI = -0.016 to -0.003, p = 0.007) were found to significantly predict higher pain severity, and lower social functioning was found to significantly predict lower PSE (beta = 0.196; 95% CI = -0.130 to 0.273, p = 0.002). PSE did not mediate the relationship between biopsychosocial functioning and pain severity, and psychological functioning did not significantly predict pain severity or PSE. These findings suggest that social functioning is an important factor in predicting outcomes and has a number of treatment implications.