The Role of Catastrophizing in Enhancing Pain Interference and Depressive Symptoms in Endometriosis: A Longitudinal Examination

Background: Endometriosis is a prevalent condition characterised by chronic pelvic pain, significantly impacting women's quality of life and well-being. Pain catastrophizing is a cognitive tendency of exaggerated worrying, a sense of helplessness, and amplification of distressing thoughts in response to pain. According to the Fear-Avoidance Model, catastrophizing contributes to prolonged pain interference and mood disorders. This longitudinal study examines the relationship between pain catastrophizing, pain interference, and depressive symptoms in patients with endometriosis. Methods: A sample of 128 cisgender women with endometriosis recruited from online patient associations completed self-report measures assessing pain catastrophizing, pain interference, and depressive symptoms at baseline (T1) and after 6 months (T2). A mediation model examining the indirect effect of pain catastrophizing on depressive symptoms through pain interference was tested. The pelvic pain level was considered as a covariate in the model. Results: More than half of the sample reported depressive symptoms above the cut-off. Pain catastrophizing at T1 significantly predicted depressive symptoms at T2. Pain interference partially mediated this relationship. Conclusions: Our findings indicate that heightened levels of catastrophizing correlate with increased pain interference, which, in turn, predicts elevated depressive symptoms over time. Findings suggest that by targeting catastrophizing tendencies, clinicians may help mitigate depressive symptomatology. Significance Statement: This longitudinal study investigates for the first time the impact of pain catastrophizing on pain interference and depressive symptoms over time in cisgender women with endometriosis. Findings indicated both a direct influence of pain catastrophizing on depressive symptomatology and an indirect effect via increased pain interference, in line with the Fear-Avoidance Model. These findings underscore the importance of targeting pain catastrophizing tendencies in interventions aimed at improving the well-being of patients affected by endometriosis.