THE CONTRIBUTION OF FAMILY COHESION AND THE PAIN-COPING PROCESS TO DEPRESSIVE SYMPTOMS IN FIBROMYALGIA

This research evaluated a model for examining the role of family cohes ion and the pain-coping process in predicting depressive symptoms in f ibromyalgia, a chronic pain disorder of unknown etiology. Depressive s ymptoms were highly prevalent in this patient group. Fifty-nine percen t of the sample met or exceeded the cutoff score of 16 for depression on the Center for Epidemiological Studies Depression Scale (CES-D), wh ile slightly greater than 50% exceeded the cutoff score of 19, a figur e that is suggested for evaluating depression in chronic pain populati ons. Multiple regression analyses, controlling for demographic factors and medication use, revealed that low family cohesion (either reporte d by the patient or the patient's spouse), high pain, high helplessnes s, and high passive coping contributed independently to greater CES-D scores. Pain also was related to higher depression scores indirectly t hrough its association with greater helplessness and passive coping. I n contrast, no indirect effects of family cohesion were found on depre ssive symptoms through pain, helplessness, and passive coping. Structu ral equation modeling procedures provided confirmatory evidence of the significance of these relationships, indicating a high degree of good ness-of-fit with the model examined. The data illustrate the import of a multidimensional framework for conceptualizing physical, psychologi cal, and social determinants of depressive disturbance in fibromyalgia .