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abstracts & posters

Depressive symptoms and disease management self-efficacy, not catastrophizing, predict pain interference independent of pain severity in sickle cell disease: results from the baseline IMPORT study

key information

source: The Journal of Pain

year: 2013

authors: P. Carroll, C. Haywood, S. Lanzkron, S. Bediako, G. Onojobi, M. Diener-West, J. Haythornthwaite, M. Beach


Sickle cell disease (SCD) is an autosomal recessive hemoglobinopathy that causes both acute and chronic pain. Adults with SCD also carry a high burden of medical complications which impair function and quality of life. This study aimed to determine psychosocial variables that predict pain interference beyond that predicted by pain severity, disease complications, and basic demographics (age and sex). Participants were enrollees in the Improving Patient Outcomes with Respect and Trust (IMPORT) SCD cohort study who had complete data for all predictors (n=235, mean age 35.6 yr., 55.3% female). A “best subset” model selection procedure was used to find the best model predicting pain interference measured by the Brief Pain Inventory (BPI). Predictors included a comprehensive group of psychosocial measures: disease management self-efficacy, BPI pain severity, pain-related catastrophizing (Pain Catastrophizing Scale, PCS), stress (Urban Life Stress Scale), and depressive symptoms (10-item Center for Epidemiologic Studies Depression Scale, CES-D). Chart abstracted comorbidities that might indicate more severe disease or greater impairment were entered as well, including depressive disorder, avascular necrosis of bone, a history of cerebrovascular accidents, prior acute chest syndrome, and pulmonary hypertension. We used an automated algorithm in the R statistical computing environment to produce the best models of each possible length according to Bayesian Information Criterion (BIC). Thereafter, these models were compared on BIC. The best model contained three predictors: pain severity, depressive symptoms, and disease management self-efficacy. A two-predictor model lacking self-efficacy was only marginally inferior. These findings suggest that psychosocial interventions for pain-related function in SCD should target depressive symptoms, and possibly disease management self-efficacy.

organization: Johns Hopkins University, Baltimore

DOI: 10.1016/j.jpain.2013.01.732

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