Pain catastrophizing, chronic pain, depression and quality of life in women with endometriosis

OBJECTIVE To investigate the psychosocial factors related to the quality of life (QoL) of women suffering from endometriosis. METHOD A cross-sectional study was conducted of 155 women diagnosed with endometriosis, using five self-completed questionnaires which were administered electronically. These comprised a questionnaire covering demographic and medical information and four standardized scales: the Chronic Pain Grade Questionnaire, measuring chronic pain, the Beck Depression Inventory, the Pain Catastrophizing Scale, and the Endometriosis Health Profile (EHP-30), a disease-specific QoL scale. RESULTS Concerning diagnostic delay, the average time from onset of symptoms to diagnosis of endometriosis was 5.8 years. Positive correlation was observed between pain intensity and depression (r=0.334, p<0.001), and between catastrophizing and chronic pain intensity (r=0.543, p<0.001). Pain catastrophizing (i.e., rumination, magnification, and helplessness) was found to mediate the relationship between chronic pain intensity and QoL or depression. Based on hierarchical regression analysis, pain catastrophizing was found to be significantly associated with QoL (B=0.578, p<0.001), taking into account demographic and clinical variables. CONCLUSIONS Endometriosis is a disease which affects a woman's life in various ways, both physically and psychosocially. The study findings emphasize the need to focus attention on the psychological dimensions of the disease (namely, experienced pain intensity and pain catastrophizing). Acknowledging the subjective experience of pain will help women to cope with the disease, with appropriate psychological intervention aimed at improving their mental health and health-related QoL. Interdisciplinary cooperation among health care professionals is important for the timely and effective treatment of endometriosis and its psychological dimensions.