Association of sense of coherence and depression in patients with chronic pain: a systematic review and meta-analysis

Alejandra Aguilar-Latorre, Bárbara Oliván Blázquez, Ángela Asensio-Martínez, Celia Álvarez Bueno, Iván Cavero Redondo, Magallon Botaya

Keywords: Sense of coherence, depression, chronic pain, systematic review, meta-analysis

Chronic pain is a significant complaint that generates distressing consequences for those who suffer it. Pain and depression concur as a context of comorbidity and both share underlying stress conditions. Sense of coherence (SOC) is a factor that determines how well a person manages stress and stays healthy. Its relationship with depression is highly reported.

Research questions:
Our objective was to assess the size of the available evidence on the association of SOC with depression in patients with chronic pain.

A systematic review and meta-analysis were performed. Searches were conducted from April 01 to May 31, 2020, in PubMed, Web of Science, Embase, PsycINFO, Psicodoc, ScienceDirect and Dialnet. The evidence regarding the relationship between SOC and depression in patients with chronic pain was summarized and compared.

162 articles were identified. Ten studies were included in the qualitative analysis and nine in the quantitative analysis. The pooled correlation coefficient was -0.55 (95%: -0.70; -0.41). The heterogeneity across the studies was considerable (I2 = 94.8%; p < 0.001). The sensitivity analysis showed that the pooled correlation coefficient was not modified after removing any study. The random‐effects meta‐regression models for the association between SOC and depression showed that age (p = 0.148) and the percentage of women (p = 0.307) were not related to heterogeneity across studies. No publication bias was detected (p = 0.720).

The included studies indicate that SOC is an important factor in depression levels in chronic pain patients. Most of the included studies showed a moderate association between SOC and depressive symptoms. Our results therefore present implications for the design of healthy public policies and rehabilitation programs. Adopted a systematic salutogenic orientation to focus on cognitive and emotional resources that are available, strengthen them and created new ones would be very useful.

Points for discussion:
Health promotion research could be based on the Salutogenesis model.

Clinicians who care for patients with chronic pain should take into consideration their patients’ psychosocial backgrounds and assess their level of SOC for analyzing the risk of depression.

As it is known, SOC may be modified by life experiences and through intervention. Mental health should be integrated across medical specialties to better manage the psychological needs of this population.