نقش واسطه‌ای فاجعه‌سازی درد، افسردگی و اضطراب در ارتباط بین انعطاف‌پذیری روان‌شناختی با خودکارآمدی درد بیماران مبتلا به دردهای عضلانی- اسکلتی

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دانشجوی کارشناسی ارشد روانشناسی سلامت، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 دانشیار، گروه روانشناسی سلامت، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 استاد، گروه روانشناسی سلامت، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

4 استاد، گروه آمار زیستی و اپیدمیولوژی، دانشکده‌ی بهداشت، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

5 دانشیار روماتولوژی، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقاله پژوهشی




مقدمه: دردهای عضلانی- اسکلتی، از شایع‌ترین دردها در مراجعین به مراکز درمانی است که می‌تواند دارای ابعاد روان‌شناختی باشد. هدف پژوهش حاضر، تدوین مدل ساختاری در تبیین نقش واسطه‌ای فاجعه‌سازی درد، افسردگی و اضطراب بین انعطاف‌پذیری روان‌شناختی با خودکارآمدی درد بیماران مبتلا به دردهای عضلانی- اسکلتی بود.
روش‌ها: در یک مطالعه‌ی مقطعی، 200 بیمار مبتلا به دردهای مزمن عضلانی- اسکلتی به روش نمونه‌گیری در دسترس از میان مراجعه‌کنندگان به مراکز درمانی وابسته به دانشگاه علوم پزشکی اصفهان در 1400-1399 انتخاب شدند. شرکت‌کنندگان واجد شرایط ورود به مطالعه، پرسش‌نامه‌های پذیرش درد مزمن
(Chronic Pain Acceptance Questionnaire)، گسلش شناختی (Cognitive Fusion Questionnaire)، خود مشاهده‌گر (Self-Experience Questionnaire)، زندگی ارزش‌محور (Value-based Life Questionnaire)، اقدام متعهدانه (Committed Action Questionnaire)، خودکارآمدی درد
(Pain Self-Efficacy Questionnaire) و مقیاس‌های بهشیاری (Mindful Attention Awareness Scale)، فاجعه‌سازی درد (Pain Catastrophizing Scale) و اضطراب و افسردگی بیمارستانی (Hospital Anxiety and Depression Scale) را تکمیل کردند. داده‌ها با روش آماری معادلات ساختاری مورد تجزیه و تحلیل قرار گرفت.
یافته‌ها: نتایج پژوهش نشان داد، ضریب میزان تأثیر مستقیم فاجعه‌سازی درد، اضطراب، افسردگی و انعطاف‌پذیری روان‌شناختی بر خودکارآمدی درد به ترتیب 0/357، 0/255، 0/127 و 0/849 است و در سطح 99 درصد اطمینان این تأثیر معنی‌دار است (0/01 > P). انعطاف‌پذیری روان‌شناختی به صورت غیرمستقیم با میانجیگری فاجعه‌سازی درد، اضطراب، افسردگی بر خودکارآمدی درد (502-/0) تأثیر می‌گذارد (0/01 > P). رابطه‌ی کل بین انعطاف‌پذیری روان‌شناختی و خودکارآمدی درد (0/346) می‌باشد. برای آزمایش مناسب بودن تناسب مدل‌ها، از شاخص برازش مقتصد هنجار شده (NFI)، شاخص تاکر-لوئیس (TLI)، شاخص برازش تطبیقی (CFI) و شاخص برازش افزایشی (IFI) استفاده شد که در محدوده‌ی قابل قبولی بودند.
نتیجه‌گیری: متغیر انعطاف‌پذیری روان‌شناختی با میانجی‌گری فاجعه‌سازی درد، افسردگی و اضطراب، پیش‌بینی‌کننده‌ی خودکارآمدی درد می‌باشد و به نظر می‌رسد انعطاف‌پذیری روان‌شناختی با تعدیل اثر فاجعه‌سازی درد، افسردگی، اضطراب، خودکارآمدی درد را افزایش می‌دهد. در نهایت بهبود این عوامل روان‌شناختی ممکن است بر روند مدیریت بهتر بیماری تأثیر بگذارد.

کلیدواژه‌ها

عنوان مقاله [English]

The Mediating role of Pain Catastrophe, Depression and Anxiety in the Relationship between Psychological Flexibility and Pain Self-Efficacy in Patients with Musculoskeletal Pain

نویسندگان [English]

  • Shila Kermani 1
  • Amrolah Ebrahimi 2
  • Reza Bagherian-Sararoudi 3
  • Awat Feizi 4
  • Peyman Mottaghi 5
1 MSc Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 Associate Professor, Department of Health Psychology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
3 Professor, Department of Health Psychology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
4 Professor, Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
5 Associate Professor, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
چکیده [English]

Background: Musculoskeletal pain is one of the most common pains in patients referred to medical centers which may have a psychological basis. The aim of this study was to develop a structural model to explain the mediating role of catastrophizing pain, depression and anxiety between psychological flexibility and pain self-efficacy in patients with musculoskeletal pain.
Methods: In a cross-sectional study, 200 patients with chronic musculoskeletal pain were selected by convenience sampling method from those referred to medical centers affiliated to Isfahan University of Medical Sciences in 2020-2021. Eligible participants filled out: Chronic Pain Acceptance Questionnaire (CPAQ), Cognitive Fusion Questionnaire (CFQ), Self-Experience Questionnaire (SEQ), Value-based Life Questionnaire (VLQ), Committed Action Questionnaire (CAQ-8), Pain Self-Efficacy Questionnaire (PSEQ) and the Mindful Attention Awareness Scale (MAAS), Pain Catastrophizing Scale (PCS), and Hospital Anxiety and Depression Scale (HADS). Then the data were analyzed using SPSS-24 and AMOS software and statistical methods of regression analysis and structural equations.
Findings: The results showed that the direct effect coefficient of pain catastrophizing, anxiety, depression and psychological flexibility on pain self-efficacy is (0.357), (0.255), (0.127) and (0.849) respectively. The total relationship between psychological flexibility and pain self-efficacy is (0.346). To test the suitability of the models, NFI, TLI, CFI and IFI indices were used, which were within acceptable limits.
Conclusion: The psychological flexibility variable predicts pain self-efficacy mediated by catastrophic pain, depression and anxiety (P < 0.01, r = 0.85) and it appears that predicting pain catastrophe, depression, anxiety and psychological resilience can increase pain self-efficacy. Ultimately, the improvement of these psychological factors may affect the process of better disease management.

کلیدواژه‌ها [English]

  • Catastrophizing
  • Depression
  • Anxiety
  • Flexibility
  • Self-Efficacy

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مجله دانشکده پزشکی اصفهان
دوره 40، شماره 690
هفته 2 آذرماه
آذر و دی 1401
صفحه 789-799

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