(PS1-98) The Interaction of Pain Interference and Cognitive Flexibility in Relation to Depression Among Emerging Adults with Pain

Pain and depression are highly comorbid conditions that commonly occur in emerging adults (age 18-24). Cognitive flexibility, or the ability to think and respond adaptively in the face of stressful stimuli, is a transdiagnostic construct that has been implicated in the development of both chronic pain and depression. Although low levels of cognitive flexibility are associated with poorer depression- and pain-related outcomes in adults generally, no extant research has examined how the relation between pain interference (i.e., the perceived impact of pain on everyday activities) and lower cognitive flexibility may worsen depression in a population of emerging adults with pain. The purpose of this study was to examine cognitive flexibility as a moderator of associations between pain interference and depression. Public university students (N = 672; Mage = 18.1) in the northeastern United States who endorsed any pain in the past 3 months (74% female, 68% White) completed measures, including the Pain Interference subscale from the Graded Chronic Pain Scale, the Cognitive Flexibility Inventory, and the Center for Epidemiologic Studies Depression Scale. First, we tested bivariate correlations between all variables. Next, a conditional effects model (PROCESS Macro) was used to test cognitive flexibility as a moderator of associations between pain interference and depression, controlling for age, gender, and race. Bivariate correlations showed greater pain interference was associated with greater levels of depression symptoms (r = .41, p < .01), while lower levels of cognitive flexibility were associated with greater pain interference (r = -.11, p < .01) and greater levels of depression symptoms (r = -.36, p < .01). In the conditional effects model, the interaction between pain interference and cognitive flexibility was significant (B = -.04, t = -2.77, p = .006), such that associations between pain interference and depression became stronger as cognitive flexibility decreased. Findings indicate that emerging adults with pain may experience more severe depression when they lack the cognitive flexibility to respond adaptively to pain-related interference with their daily functioning. Further research may examine prospective associations among pain interference, cognitive flexibility, and depression in a population of emerging adults with chronic pain. Given evidence that increased cognitive flexibility is associated with improvements in pain interference and depression, future research should also consider cognitive flexibility as a transdiagnostic target for integrated interventions designed to address depression in the context of pain among emerging adults.