Does a diagnosis of depression influence observer ratings of pain severity? The mediating role of causal attributions of pain and pain genuineness

Researchers have been increasingly investigating observer and patient characteristics that may influence the assessment of pain in others. While rates of psychiatric conditions are high in chronic pain populations, surprisingly little attention has been given to if (and why) a comorbid psychiatric diagnosis may influence the estimation of pain in others. Using an experimental vignette paradigm, the current study examined whether a diagnostic label of major depressive disorder (MDD) would impact observer pain estimates of a woman with chronic pain, and whether causal attributions of pain and pain genuineness might help explain these effects. Participants ( n = 188) were given a vignette describing a female patient with chronic pain (who either had MDD or no mental health concerns), viewed a brief video clip of the patient, and then were asked to provide a variety of ratings about the woman’s pain. Results of a serial multiple mediation analysis revealed that participants in the MDD condition made greater psychological attributions for the woman’s pain, which was associated with lower perceptions of pain genuineness, which was then associated with lower estimates of pain intensity. These findings suggest that a diagnosis of depression may indirectly influence observer estimates of another person’s pain by heightening psychological attributions of pain, and making their pain seem less genuine. Further research is needed to elucidate the complex processes underlying pain estimation, including patient and observer characteristics, biases, and heuristics, in order to improve quality of care for those living with persistent pain.’