Health-related quality of life in adolescents with persistent pain and the mediating role of self-efficacy: a cross-sectional study

Abstract

Background: Persistent pain has a high prevalence among adolescents. Pain has been shown to reduce all aspects of the adolescent's health-related quality of life (HRQOL). In adult patients with pain, self-efficacy has been shown to mediate the relationship between pain intensity, disability and depression. However, little is known about whether self-efficacy acts as a mediating variable in the relationship between persistent pain and HRQOL sub-scale scores in a school-based population of adolescents. Objectives: To describe the experience of pain, HRQOL and self-efficacy, and to explore the association between pain intensity, general self-efficacy and HRQOL in adolescents with persistent pain by testing self-efficacy as a possible mediator. Methods: The study participants were 78 adolescents with persistent pain, aged 16-19 years, who were recruited from five high schools in southern Norway. All participants completed an electronic survey consisting of the Lubeck Pain Questionnaire, which included a visual analogue scale (VAS) measuring pain intensity, the General Self-Efficacy Scale (GSE) and the KIDSCREEN-52 Questionnaire measuring HRQOL. Statistical analyses were conducted using the PROCESS macro for SPSS developed by Andrew Hayes.Results: All participants reported pain in multiple locations, of which the head was most common (88.5%). Mean (SD) pain intensity score of the participants was 5.4 (1.8). The study sample had poor HRQOL, with mean (SD) scores for several sub-scales ranging from 45.2 (21.0) to 91.0 (13.3) on a 0-100 scale. The associations between pain intensity and the HRQOL sub-scales of physical well-being, psychological well-being, mood, self-perception, autonomy and school environment were mediated by self-efficacy. The highest degree of mediation and, thus, the largest indirect effect was estimated for the HRQOL sub-scale physical well-being (67.2%). Conclusions:This school-based sample of adolescents with persistent pain had impaired HRQOL. Up to 67% of the reduction in the HRQOL sub-scale scores for physical well-being, psychological well-being, mood, self-perception, autonomy and school environment could be explained by the mediating variable self-efficacy. Thus, future painmanagement interventions that aim to increase HRQOL in school-based populations of adolescents with persistent pain should consider promoting self-efficacy and providing more targeted interventions.Trial registration: ClinicalTrials.gov ID NCT03551977.

Associations between pain, self-efficacy, sleep duration, and symptoms of depression in adolescents: a cross-sectional survey

“…SE is a positive phenomenon, and it is particularly relevant from a health promotion perspective because SE focuses on resources rather than problems (23,25,42). In pain research, studies have shown that a high level of SE may be characterized as a protective psychological resource, and related to several positive health outcomes, such as greater ability to cope with pain, better quality of life, and fewer somatic symptoms (22,43,44). Surprisingly, our analyses did not reveal a significant association between high SE and daily pain in any location of any form.…”

“…A higher score denotes a higher level of SE. This scale has been shown to be reliable and valid, as indicated by a Cronbach's  between 0.75 and 0.90 (22,24,25).…”

“…In pain research, SE has been defined in terms of a person's confidence in his or her ability to cope with the symptoms, stresses, or limitations associated with a pain condition (20). Previous studies of pain and SE have shown that a high level of SE is related to both a greater ability to cope with pain and better quality of life (21,22).…”

Pain and health-related quality of life in adolescents and the mediating role of self-esteem and self-efficacy: a cross-sectional study including adolescents and parents

“…Studies have shown that self-efficacy and self-esteem have a positive impact on both pain and HRQOL in adolescents [ 18 , 35 – 43 ]. Higher levels of self-efficacy and self-esteem may protect an adolescent from experiencing pain, it can help to positively adapt and cope with pain, and it is associated with higher levels of HRQOL despite having pain [ 18 , 22 , 38 , 41 , 42 ].…”

Analysis of the Dimensions of Quality of Life in Colombian University Students: Structural Equation Analysis

“…These data suggest the idea that physical and cognitive wellbeing can affect other wellbeing dimensions, influencing them positively [32]. When Physical and Psychological Wellbeing increase, then Mood and Emotions, Self-Perception, and Autonomy do in the same way, with the understanding that these types of wellbeing affect the rest and the dimensions are positively related [33].…”