Pain catastrophizing, pain intensity, and dyadic adjustment influence patient and partner depression in metastatic breast cancer

Abstract

Objective: Metastatic breast cancer can be challenging for couples given the significant pain and distress caused by the disease and its treatment. Although the use of catastrophizing (eg, ruminating, exaggerating) as a pain coping strategy has been associated with depression in breast cancer patients, little is known about the effects of pain intensity on this association. Moreover, even though social relationships are a fundamental resource for couples coping with cancer, no studies have examined whether the quality of the spousal relationship affects the association between catastrophizing and depression. This study prospectively examined these associations.

Methods: Couples (N=191) completed surveys at the start of treatment for metastatic breast cancer (baseline), and 3 and 6 months later.

Results: Multilevel models using the couple as the unit of analysis showed patients and partners (ie, spouses or significant others) who had high levels (+1 SD) of dyadic adjustment (DAS-7) experienced fewer depressive symptoms than those who had low levels (-1 SD) of dyadic adjustment (P's<0.01). Moreover, at low levels of dyadic adjustment, when patients engaged in high levels of catastrophizing and had high levels of pain, both patients and partners reported significantly (P=0.002) higher levels of depression than when patients engaged in high levels of catastrophizing but had low levels of pain.

Discussion: Findings showed that catastrophizing and pain exacerbate depression in couples experiencing marital distress. Programs that seek to alleviate pain and depressive symptoms in metastatic breast cancer may benefit from targeting both members of the couple, screening for marital distress, and teaching more adaptive pain coping strategies.

Figure 1

Results of multilevel analysis among (a) high dyadic adjustment (DAS-7) patients (+1 SD) and (b) low dyadic adjustment patients (−1 SD) regressing depression (CES-D) scores on patient reports of catastrophizing with pain intensity (BPI) as a moderator.