Effect of anxiety symptoms on pain severity in patients with major depressive disorder： the parallel mediating roles of depressive symptoms and pain vigilance and awareness
10.11886/scjsws20260127002
- VernacularTitle:焦虑症状对重性抑郁障碍患者疼痛程度的影响：抑郁症状、疼痛警觉性与意识的平行中介作用
- Author:
Songying FANG
1
;
Bingjie ZHOU
1
;
Hongjie CHEN
1
;
Chenjiao ZHANG
2
;
Jingxu CHEN
3
Author Information
1. Chengde Medical College， Chengde 067000， China
2. Bengbu Medical University， Bengbu 233030， China
3. Beijing Huilongguan Hospital， Capital Medical University， Beijing 100096， China
- Publication Type:Journal Article
- Keywords:
Anxiety;
Major depressive disorder;
Pain;
Mediation analysis
- From:
Sichuan Mental Health
2026;39(3):234-239
- CountryChina
- Language:Chinese
-
Abstract:
BackgroundPain is one of the most common physical symptoms in patients with major depressive disorder （MDD）. The high comorbidity rate of MDD and pain aggravates patients' physical and psychological distress， undermines their treatment adherence， and contributes to poor clinical outcomes， posing a critical challenge for the clinical management of MDD. Anxiety symptoms are strongly associated with the pain severity in patients with MDD， yet the underlying mechanisms of the association remain poorly elucidated. Accumulating evidence have indicated that depressive symptoms and pain vigilance and awareness are involved in the modulation of pain perception. Nevertheless， few studies have incorporated these variables into an integrated analytical framework to clarify their parallel mediating effects on the relationship between anxiety symptoms and pain severity. ObjectiveTo explore the mediating pathways linking anxiety symptoms to pain severity via depressive symptoms and pain vigilance and awareness in patients with MDD， so as to provide insights for precise intervention for MDD accompanied by pain symptoms. MethodsA total of 249 patients who met the diagnostic criteria for MDD specified in the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） were recruited from Beijing Huilongguan Hospital from May to September 2025. Hamilton Depression Scale-17 item （HAMD-17）， Hamilton Anxiety Scale （HAMA）， Pain Vigilance and Awareness Questionnaire （PVAQ） and Numerical Rating Scale （NRS） were used for assessment. Partial correlation analyses were performed to examine correlations among these variables. Parallel mediating effects were tested using model 4 of the Process macro for SPSS， with depressive symptoms and pain vigilance and awareness as parallel mediators linking anxiety symptoms to pain severity. ResultsA total of 135 patients （54.22%） reported pain， comprising 59 （43.70%） with mild pain， 43 （31.85%） with moderate pain， and 33 （24.45%） with severe pain. Partial correlation analyses revealed significant positive correlations among HAMD-17， HAMA， PVAQ， and NRS scores in patients with MDD （r=0.198–0.424， P<0.05 or 0.01）. Anxiety symptoms positively predicted pain severity， with a direct effect of 0.128 （95% CI： 0.065–0.190）. Both depressive symptoms and pain vigilance and awareness acted as partial mediators linking anxiety symptoms to pain severity. The indirect effects were 0.057 （95% CI： 0.029–0.089） and 0.042 （95% CI： 0.016–0.079）， accounting for 25.22% and 18.58% of the total effect， respectively. ConclusionIn patients with MDD， anxiety symptoms exert a positive predictive effect on pain severity， which is partially mediated through the parallel roles of depressive symptoms and pain vigilance and awareness.
