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      The relationship of self-efficacy to catastrophizing and depressive symptoms in community-dwelling older adults with chronic pain: A moderated mediation model

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          Abstract

          Self-efficacy has been consistently found to be a protective factor against psychological distress and disorders in the literature. However, little research is done on the moderating effect of self-efficacy on depressive symptoms in the context of chronic pain. This cross-sectional study aimed to examine if pain self-efficacy attenuated the direct relationship between pain intensity and depressive symptoms, as well as their indirect relationship through reducing the extent of catastrophizing when feeling pain (moderated mediation). 664 community-dwelling Chinese older adults aged 60–95 years who reported chronic pain for at least three months were recruited from social centers. They completed a battery of questionnaires on chronic pain, pain self-efficacy, catastrophizing, and depressive symptoms in individual face-to-face interviews. Controlling for age, gender, education, self-rated health, number of chronic diseases, pain disability, and pain self-efficacy, pain catastrophizing was found to partially mediate the connection between pain intensity and depressive symptoms. Furthermore, the relationship between pain intensity and depressive symptoms was moderated by pain self-efficacy. Self-efficacy was also found to moderate the relationship between pain intensity and catastrophizing and the moderated mediation effect was confirmed using bootstrap analysis. The results suggested that with increasing levels of self-efficacy, pain intensity’s direct effect on depressive symptoms and its indirect effect on depressive symptoms via catastrophizing were both reduced in a dose-dependent manner. Our findings suggest that pain self-efficacy is a significant protective factor that contributes to psychological resilience in chronic pain patients by attenuating the relationship of pain intensity to both catastrophizing and depressive symptoms.

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          Most cited references27

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          An Index and Test of Linear Moderated Mediation.

          I describe a test of linear moderated mediation in path analysis based on an interval estimate of the parameter of a function linking the indirect effect to values of a moderator-a parameter that I call the index of moderated mediation. This test can be used for models that integrate moderation and mediation in which the relationship between the indirect effect and the moderator is estimated as linear, including many of the models described by Edwards and Lambert ( 2007 ) and Preacher, Rucker, and Hayes ( 2007 ) as well as extensions of these models to processes involving multiple mediators operating in parallel or in serial. Generalization of the method to latent variable models is straightforward. Three empirical examples describe the computation of the index and the test, and its implementation is illustrated using Mplus and the PROCESS macro for SPSS and SAS.
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            Resilience and development: Contributions from the study of children who overcome adversity

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              Theoretical perspectives on the relation between catastrophizing and pain.

              The tendency to "catastrophize" during painful stimulation contributes to more intense pain experience and increased emotional distress. Catastrophizing has been broadly conceived as an exaggerated negative "mental set" brought to bear during painful experiences. Although findings have been consistent in showing a relation between catastrophizing and pain, research in this area has proceeded in the relative absence of a guiding theoretical framework. This article reviews the literature on the relation between catastrophizing and pain and examines the relative strengths and limitations of different theoretical models that could be advanced to account for the pattern of available findings. The article evaluates the explanatory power of a schema activation model, an appraisal model, an attention model, and a communal coping model of pain perception. It is suggested that catastrophizing might best be viewed from the perspective of hierarchical levels of analysis, where social factors and social goals may play a role in the development and maintenance of catastrophizing, whereas appraisal-related processes may point to the mechanisms that link catastrophizing to pain experience. Directions for future research are suggested.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: ConceptualizationRole: Funding acquisitionRole: MethodologyRole: ResourcesRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 September 2018
                2018
                : 13
                : 9
                : e0203964
                Affiliations
                [1 ] Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong SAR, China
                [2 ] Department of Clinical Psychology, Norwich Medical School, University of East Anglia, United Kingdom
                [3 ] Department of Anaesthesiology & Operating Services, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
                [4 ] Department of Anaesthesiology & Operating Theatre Services, Queen Elizabeth Hospital, Hong Kong SAR, China
                [5 ] Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong SAR, China
                [6 ] Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong SAR, China
                [7 ] Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong SAR, China
                [8 ] Department of Psychiatry, North District Hospital, Hong Kong SAR, China
                University of Malaya, MALAYSIA
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                ‡ These authors also contributed equally to this work.

                Author information
                http://orcid.org/0000-0003-2923-4217
                http://orcid.org/0000-0001-5809-6875
                Article
                PONE-D-18-11394
                10.1371/journal.pone.0203964
                6143242
                30226892
                50559cba-ce79-4aed-8ba2-8d61e194d15b
                © 2018 Cheng et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 16 April 2018
                : 30 August 2018
                Page count
                Figures: 2, Tables: 3, Pages: 12
                Funding
                Funded by: Tai Hung Fai Charitable Foundation
                Award Recipient :
                This study was supported by a grant from the Tai Hung Fai Charitable Foundation to the corresponding author. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Mental Health and Psychiatry
                Mood Disorders
                Depression
                Biology and Life Sciences
                Physiology
                Sensory Physiology
                Somatosensory System
                Pain Sensation
                Medicine and Health Sciences
                Physiology
                Sensory Physiology
                Somatosensory System
                Pain Sensation
                Biology and Life Sciences
                Neuroscience
                Sensory Systems
                Somatosensory System
                Pain Sensation
                People and Places
                Population Groupings
                Age Groups
                Elderly
                Medicine and Health Sciences
                Health Care
                Patients
                Medicine and Health Sciences
                Pain Management
                Biology and Life Sciences
                Neuroscience
                Cognitive Science
                Cognition
                Medicine and Health Sciences
                Pain Management
                Pain Psychology
                Biology and Life Sciences
                Psychology
                Pain Psychology
                Social Sciences
                Psychology
                Pain Psychology
                Research and Analysis Methods
                Research Design
                Cross-Sectional Studies
                Custom metadata
                Data are available via Figshare: https://doi.org/10.6084/m9.figshare.6143507.v2.

                Uncategorized
                Uncategorized

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