Survive or Thrive? Longitudinal Relation Between Chronic Pain and Well-Being

Salutogenic health measures: Psychometric properties of the Danish versions of the Flourish Index and the Secure Flourish Index

Measurement of human flourishing represents a salutogenic approach to epidemiological and behavioral research emphasizing factors contributing to "good lives" rather than pathology. The objective of this study was to translate and psychometrically test the 10-item Flourish Index (FI) and 12-item Secure Flourish Index (SFI) in a convenience sample of Danish adults. A total of 325 participants completed a cross-sectional survey, with 148 of those participants completing the survey a second time (retest). Confirmatory factor analysis in a structural equation modelling framework was used to establish structural validity by comparing four different pre-specified models of the indexes. Additionally, internal consistency, convergent and incremental validity, and retest reliability were examined. The FI models exhibited superior structural validity compared with similar models of the SFI, although all models had good fits. Internal consistencies with McDonald's omega were 0.89 and 0.87 for the FI and SFI, respectively. The five (FI) or six (SFI) domains were happiness & life satisfaction, mental & physical health, meaning & purpose, character & virtue, close social relationships, and financial & material stability (λ4 = 0.51-0.91). Convergent and incremental validity tests supported predefined hypotheses. Retest analyses with the FI and SFI showed a high degree of retest reliability. Based on the psychometric evidence reported in this study, the Danish Flourish Index and Secure Flourish Index seem suitable for use with healthy adult Danes. The authors hope that this psychometric evaluation of the FI and SFI will stimulate research on patterns, health and economic outcomes, and predictors of human flourishing in Denmark.

Age as a moderator in the interplay among locus of control, coping, and quality of life of people with chronic pain

OBJECTIVE

Identifying the factors that determine the quality of life of patients with chronic pain is an integral part of developing interventions to reduce the negative impact of persistent pain. Locus of control (LoC) could play an important role in adaptation to prolonged pain, but the results of studies are inconsistent. We examined the link between pain LoC and quality of life. Moreover, we investigated whether the relationship between LoC and quality of life is mediated by passive and active coping, and whether age moderates the LoC-coping relationship.

METHODS

The study was cross-sectional, and variables (internal, chance and powerful-others LoC, pain coping strategies, average pain intensity, and quality of life) were assessed via questionnaires in a sample of 594 individuals (67% females) with chronic pain who were 18-72 (mean: 36) years of age.

RESULTS

Mediation and moderated mediation analyses were conducted. Internal and external LoC were associated, respectively, with better and with worse quality of life. Passive coping mediated the association between the powerful-others dimension of LoC and poor quality of life. Additionally, indirect effects of internal LoC on quality of life via passive and active coping were found. The relationship between the powerful-others dimension of LoC and coping was stronger for middle-aged and older individuals than for younger individuals.

CONCLUSIONS

This study contributes to a better understanding of the mechanisms linking LoC with quality of life of patients with chronic pain. Depending on the age, control beliefs might translate differently into strategies used to cope with pain, and thus into quality of life.

Work-family conflicts and pain interference among midlife adults: a longitudinal serial mediation via family strain and loneliness

OBJECTIVE

Work-family conflict has been shown to adversely affect individuals' health and function, particularly among individuals with chronic pain. The current study's longitudinal serial mediation model examined whether work-to-family conflict predicted greater pain interference through higher levels of family strain and loneliness among midlife adults with chronic pain.

METHODS AND MEASURES

The study consisted of 303 participants from two waves of the national longitudinal study of Midlife in the United States (MIDUS) at wave II from 2004 to 2006 (Mage = 57, SD = 11) and wave 3 from 2013 to 2014 (Mage = 66, SD = 11). Participants were employed at time 1 and had chronic pain at both time points, and 54.5% of participants identified as female.

RESULTS

Family strain at time 1 (T1) and loneliness at time 2 (T2), respectively, significantly mediated the association of work-to-family conflict (T1) on pain interference at T2. Participants with greater work-to-family conflict perceived more family strain, felt lonelier, and, in turn, reported experiencing higher interference from chronic pain.

CONCLUSION

Results suggest that unmanaged work-to-family conflict could be a risk factor that exacerbates chronic pain symptoms through worsening family relationships and loneliness among midlife adults with chronic pain.

Positive psychology interventions can improve mental health for chronic pain patients: a systematic review and meta-analysis

OBJECTIVE

This study examines the efficacy of positive psychology interventions (PPIs) for patients with chronic pain through a systematic review and meta-analysis. PPIs are defined as strategies that involve focusing on positive emotions, thoughts, and behaviors that improve mental health by increasing mental well-being and reducing psychological distress.

DESIGN

The search was conducted using the PubMed, Scopus, PsycINFO, and Cochrane Library databases.

MAIN OUTCOME MEASURES

Subjective, psychological, and social well-being were used as indicators of mental well-being, and depression, anxiety, and stress symptoms were used as indicators of psychological distress. Results: Nine studies were included. Eight studies evaluated subjective well-being, seven evaluated depression, and three evaluated anxiety symptoms. No studies examined psychological well-being, social well-being, or stress. PPIs were found to be effective in promoting subjective well-being post-treatment (Hedges' g = 0.40; 95% CI [0.06, 0.73]) and reducing anxiety (Hedges' g = -0.32, 95% CI [-0.59, -0.06]), but no significant results were found for depression (Hedges' g = -0.23, 95% CI [-0.50, 0.04]).

CONCLUSION

The included investigations, while limited, suggest the utility of PPIs in mitigating the psychological consequences of chronic pain. Researchers and practitioners are encouraged to implement PPI practices.

Pain, Goal Engagement, and Eudaemonic Well-Being: Moderation by Autonomous Motivation

OBJECTIVES

Pain may decrease well-being in older adults by limiting social and leisure activities. However, some activities can exacerbate pain. We hypothesized that autonomously motivated goal engagement could ameliorate negative effects of pain on goal engagement and amplify positive effects of goal engagement on eudaemonic well-being (EWB).

METHOD

Midlife and older women (N=200) were oversampled for chronic pain. Daily diaries (n=10,697) including goal lists and ratings, pain, and EWB were completed for 7 days every 3 months for 2 years.

RESULTS

Pain was not a correlate of goal engagement. More engagement was associated with higher EWB when motivation was autonomous. However, more goal engagement correlated with lower EWB the next day and, when not autonomously motivated, higher pain.

DISCUSSION

Goal engagement can benefit people with or without physical pain, but the motivation behind goal engagement is equally if not more important. Goals motivated by autonomous sources increase EWB and may protect against maladaptive patterns of activity associated with pain.