Pain Catastrophizing as a Mediator of the Relationship between Pain Intensity and Depression: Evidence from Chronic Pain Patients in Gaza

Background: Chronic pain represents a major global public health issue. It is associated with wide-ranging psychosocial consequences. Extensive evidence has demonstrated that pain catastrophizing (PC) contributes to the bidirectional association between chronic pain and psychological distress. The present study aims to explore the psychological and cognitive correlates of chronic pain among individuals living in Gaza. Methods: A cross-sectional study was conducted among 272 adults with chronic musculoskeletal pain. Spearman’s correlations assessed associations between pain intensity, catastrophizing and depressive symptoms. Multiple regression and bootstrapped mediation analyses (5,000 resamples and PROCESS macro) evaluated predictors and the mediating role of catastrophizing in the pain–depression relationship. Results: Pain intensity was positively correlated with depression (r = 0.28, p < 0.001) and catastrophizing (r = 0.39, p < 0.001). A stronger correlation was found between catastrophizing and depression (r = 0.54, p < 0.001). Mediation analysis demonstrated that catastrophizing fully mediated the association between pain intensity and depression (indirect effect = 0.95, 95% confidence interval = [0.65–1.29]). Conclusion: PC is a key psychological mechanism linking pain intensity and depression among patients with chronic pain in Gaza. Integrating cognitive-behavioral therapy, mindfulness and emotion regulation strategies into pain management may improve mental health outcomes in conflict-affected settings.