It’s Lonely at the Top (of the Pandemic): Depression Mediates the Impact of Loneliness on Pain-Related Catastrophizing during COVID-19

Principal Investigator: Kristin Schreiber

Authors: Jenna M. Wilson, Samantha M. Meints, K Mikayla Flowers, Carin A. Colebaugh, Robert R. Edwards, & Kristin L. Schreiber
Lay Abstract

The COVID-19 pandemic has caused increased feelings of loneliness, making it critical to understand the long-term impact of social distancing guidelines. People with chronic pain may have been more isolated as a result of these guidelines, potentially making their pain worse. Ninety-three Massachusetts residents with chronic pain completed an initial online survey during the early weeks of the pandemic (May, 2020), and a follow-up survey a year later (May, 2021). We asked individuals about their feelings of loneliness, negative thoughts about pain, and depressive symptoms. We found that greater feelings of loneliness during the early weeks of the pandemic predicted more negative thoughts and feelings of helplessness about pain a year later. Greater loneliness was also related to greater depression, and greater depression was related to more negative thoughts about pain. Our study suggests that feeling lonely in May, 2020 led to greater depression among those with chronic pain, which caused these individuals to have significantly more negative thoughts and feelings of helplessness about pain a year later. These findings suggest depression may be a promising target of treatment to decrease the impact of pain, especially under conditions of social distancing.

Scientific Abstract

Feelings of loneliness increased during the COVID-19 pandemic, including among individuals with chronic pain, exacerbating negative cognitions about pain and increasing pain’s impact. We employed validated psychometric and pain surveys to investigate the longitudinal relationship between loneliness during the early weeks of the pandemic (Time 1; May, 2020) and the degree of pain catastrophizing during the pandemic year (Time 2; May, 2021) in Massachusetts residents with chronic pain (N=93). We also examined whether depression during the pandemic year explained this relationship. Patients’ pain intensity, pain interference, pain medication use, and baseline pain catastrophizing during the early weeks of the pandemic (Time 1) were included as covariates. A mediation analysis demonstrated that there was a significant indirect effect of loneliness on pain catastrophizing through depression. The direct effect of loneliness on pain catastrophizing was no longer significant when depression was included in the model. Our findings suggest that feeling lonely may enhance depressive symptoms (hopelessness, helplessness) among those with chronic pain, and be associated with worsening in maladaptive cognitions about pain. As loneliness, depression, and catastrophizing can all be modified with interventions (e.g., CBT), studies may benefit from investigating the temporal associations among these variables over the course of empirically-supported treatments.

Clinical Implications
Feeling lonely during the COVID-19 pandemic may lead to more negative thoughts about pain. The effects of social distancing guidelines on people with chronic pain should be considered during the implementation of interventions to prevent worsening of pain.

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