Understanding the link between pain invalidation and depressive symptoms : the role of shame and social support in people with chronic pain

One in five Canadian adults live with chronic pain, while 30-60% of people with chronic pain also experience depression. This high comorbidity rate may be due, in part, to the social stigma of chronic pain, which often takes the form of invalidation and discounting the legitimacy of an individual’s pain experience. Discounting in particular is associated with worse mental health outcomes among chronic pain samples. Yet, little is known about the mechanisms through which discounting leads to depression for those living with chronic pain. In addition, social support is a known protective factor against depression in chronic pain but very little research has been done on whether social support can buffer the harmful effects of discounting. In line with models of self-stigma, which suggest that stigma is harmful only when the individual agrees with and applies stigmatizing beliefs to oneself, this study hypothesized that feelings of shame about one’s pain (i.e., pain-related shame) would link social discounting of pain to depressive symptoms, and that perceived social support would buffer harmful outcomes. A sample of 305 patients seeking treatment for chronic pain were recruited from a network of outpatient pain treatment centres. Participants completed an online survey comprised of standardized, validated questionnaires. Data was analyzed using moderated mediation analysis. Results demonstrated that higher levels of discounting were associated with higher levels of depressive symptoms, and that greater pain-related shame helped to explain this relationship. Results also revealed protective effects of general (but not peer) support on the association between discounting and depressive symptoms, such that higher perceived levels of social support weakened this relationship. Results highlight pain-related shame as a promising psychological treatment target in addressing depressive symptoms among those with chronic pain.Arts and Social Sciences, Irving K. Barber Faculty of (Okanagan)Psychology, Department of (Okanagan)Graduat