Effects of Anxiety and Depression on Pain Catastrophizing in Older Adults

elderly woman covering face, distressed
The goal of the current study was to assess the potential role of anxiety and depression on pain catastrophizing in older adults with chronic pain.

Anxiety and depression play an important role in the association between pain catastrophizing and pain intensity in older adults with chronic pain, according to study results published in The Journal of Clinical Medicine.

Pain catastrophizing, defined as a persistent negative cognitive affective style, predicts poor pain-related outcomes. The goal of the current study was to assess the potential effects of anxiety and depression on pain catastrophizing in older adults with chronic pain.

The researchers conducted a postal survey addressing pain aspects between October 2012 and January 2013. Pain catastrophizing was measured using the pain catastrophizing scale. Two subscales from the general well-being schedule were used to assess anxiety and depression. The insomnia severity index measured sleep problems and data on health behaviors was collected using the Health Curve instrument.

The survey was completed and returned by 6611 people aged ≥65 years living in southeastern Sweden, including 2790 participants with chronic pain (mean age 72.6 years, 61.1% women).

Data were analyzed using a path analysis approach, a form of multiple regression analysis that was used to control for lifestyle and sociodemographic factors. Standardized path coefficients were used to estimate effect size. The model accounted for 16.3% of anxiety, 17.1% of depression, and 30.9% of pain catastrophizing variances.

While sociodemographic factors had no direct effect on pain catastrophizing, the data suggest that pain catastrophizing was directly affected by several lifestyle factors, including current and ex-smokers. Obesity had a direct positive effect on catastrophizing.  Furthermore, number of comorbidities, pain intensity, insomnia, anxiety, and depression all had effects on increased pain catastrophizing.

Mood disorders were found to have strong direct effects on pain catastrophizing, with anxiety (standardized path coefficient, 0.324; P <.001) having a larger effect than depression (standardized path coefficient, 0.125; P <.001). The researchers reported mood aspects mediated the relationships between pain catastrophizing and other factors.

The study had several limitations, including the cross-sectional design, missing data on the use of alcohol to cope with pain, pain no information on whether the mood disorders developed before or after the chronic pain, potential non-response bias, and additional potential uncontrolled confounders.

“[T]hese findings provide for the possibility of pain prevention and management strategies targeted for older patients,” concluded the researchers.


Dong HJ, Gerdle B, Bernfort L, Levin LÅ, Dragioti E. Pain catastrophizing in older adults with chronic pain: the mediator effect of mood using a path analysis approach. J Clin Med. 2020;9(7):E2073. doi:10.3390/jcm9072073