The role of psychological distress in the relationship between the severity of pressure injury and pain intensity in hospitalized adults.

This was a cross-sectional secondary analysis, so it cannot show that pressure injury severity or distress caused pain. Psychological distress was a medication proxy, not a direct measure of distress, and medication effects were not captured. The study used one regional hospital system, so findings may not apply elsewhere. Pain was recorded only around the third day of admission, so it is a short snapshot. Many participants had pain scores of 0, and the analysis could not use methods for censored outcomes; 34.88% had 0 pain intensity. Pressure injury severity came from diagnosis codes or notes, not tested against current stages, and deep tissue pressure injury or unspecified stages were excluded. Patients who could not give a verbal Glasgow coma scale response of 4 or 5 were excluded, which may have omitted some patients able to feel pain but not report verbally. The final sample was 454 of 886 preliminary cases, after removing consecutive admissions, missing data and missing pain or severity records. The model did not include age, race, gender or comorbidity. The model was just identified, so overall model fit could not be tested. Missing data were handled by deletion after a missing completely at random test.

The article states that all authors have no conflicts with the manuscript; no funding statement is included.

Do not conclude that treating depression, anxiety or sleep disturbance will reduce pressure injury pain. Distress was measured only by medication records, and the indirect effect through distress was not significant.