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Veteran Spinal Cord Injury: An Investigation of the Mediating Role of Pain Interference on the Relationship between Pain and Emotional Distress

Carly Blaine, Dept. of Psychology, Jack Watson, and Richard Henry, Dept. of Psychology Graduate Student, with Dr. Scott McDonald, VCU School of Medicine

Background: Pain commonly co-occurs with spinal cord injury (SCI) and has been linked to poorer psychological function. SCI patients who experience chronic pain report great levels of interference with daily life.Pain interference with daily life may lead to emotional distress and depression.Objective: Using the PROCESS macro (model 4; Hayes, 2017), this study examines whether pain interference with daily life mediates a positive relationship between pain severity and mental health. Design: This study used a cross-sectional design. Setting and Participants: 221 veterans with SCI were interviewed by a psychologist during their annual evaluation at a Veteran Affairs medical center outpatient clinic. Outcome Measures: Single-item, self-report, Likert scale measures of pain severity and pain interference (M-HIP) were used along with the Patient Health Questionaire-4 (PHQ-4), a measure of mental health symptom severity. Results: Pain severity had a direct effect on mental health as well as an indirect effect through pain interference, using 5,000 bootstrap samples. The overall model was significant (F[1, 219] = 17.763, R2= .075, p < .001). The direct paths from pain severity to pain interference (b= .857, p< .001) and from pain interference to mental health (b= .929, p< .001) were both statistically significant. Further, the indirect effect of pain on mental health through pain interference was statistically significant (b= .796, 95% CI [.493, 1.140]), indicating a full mediation because the direct path from pain severity to mental health was no longer statistically significant in the model (b= .094, p= .683). Discussion: Findings suggest SCI-related emotional distress can result from the inability to participate in daily activities such as going to work, spending time with others, or engaging in hobbies due to pain. Such interference with regular life was found to significantly mediated the positive relationship between SCI-related pain and emotional distress. Future research may take a more qualitative account of how pain inhibits daily life emotionally and physically and focus on interventions designed to decrease pain’s interference with daily living.

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Faculty Advisor/Mentor

Scott McDonald, Ph.D.


Virginia Commonwealth University. Undergraduate Research Opportunities Program

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VCU Undergraduate Research Posters


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Veteran spinal cord injury: An investigation of the mediating role of pain interference on the relationship between pain and emotional distress.