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

Erik Grasaas, Sølvi Helseth, Liv Fegran, Jennifer Stinson, Milada Småstuen, Kristin Haraldstad, Erik Grasaas, Sølvi Helseth, Liv Fegran, Jennifer Stinson, Milada Småstuen, Kristin Haraldstad

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 pain-management 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.

Keywords: Adolescents; Health-related quality of life; Mediation; Persistent pain; Self-efficacy.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Schematic of our final mediation model
Fig. 2
Fig. 2
Mediation by self-efficacy of the association between pain intensity and the scores for HRQOL sub-scales a physical well-being, b psychological well-being, c mood, d self-perception, e autonomy and f school environment; p < 0.05*, p < 0.01** and p < 0.001***. Path a and b depict the indirect effects through the mediator. Path C represents the total effect and C' the direct path

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