Understanding the psychological factors linking pelvic pain and health-related quality of Life in endometriosis: the Influence of Illness representations and coping strategies

Background: Endometriosis is a prevalent chronic gynecological condition characterized by severe pelvic pain, negatively affecting women's health-related quality of life (HRQOL). The Common-Sense Model of Illness Self-regulation has revealed the importance of illness perceptions and coping strategies in explaining the impact of illness on HRQOL across several conditions. These aspects have never been assessed in endometriosis. Objectives: We aimed to explore the relationship between pelvic pain severity and HRQOL in women with endometriosis, hypothesizing that illness representations and pain-specific cognitive and behavioral maladaptive coping strategies influence this relationship. Study design: This cross-sectional study analyzed data from 273 women with endometriosis who completed an online questionnaire assessing pelvic pain severity, illness perceptions, specific pain-related coping strategies, and HRQOL. A path analysis through MPlus was conducted to examine the direct and indirect relationships between variables. Results: The analysis showed that pelvic pain severity directly influenced illness representations and HRQOL. Threat illness perceptions, characterized by negative views of endometriosis, were associated with maladaptive coping strategies (i.e., catastrophizing and illness-focused coping). These strategies further mediated the impact of illness perceptions on HRQOL, resulting in reduced HRQOL. Conclusions: The findings support the CSM framework, suggesting the role of illness representations and coping strategies in the association between pelvic pain severity and HRQOL in women with endometriosis. Clinicians are encouraged to assess and address negative illness representations and maladaptive coping strategies in this population. Future research should focus on experimental interventions aimed at modifying illness perceptions and evaluating their effects on health outcomes.