A longitudinal network analysis of pain, psychological processes and psychological and sexual distress in women with endometriosis

Br J Health Psychol. 2026 May;31(2):e70071. doi: 10.1111/bjhp.70071.

ABSTRACT

OBJECTIVES: Previous studies in endometriosis have linked the experience and impact of pain to psychological distress and sexual dysfunction. However, little is known about how these factors interact over time or how underlying cognitive-emotional processes contribute to their complex interconnections.

DESIGN: This study followed a Longitudinal Network Approach and explored the interconnections over time between pain (intensity and impact), psychopathological symptoms, sexual distress, and cognitive-emotional processes (cognitive fusion and difficulties in emotion regulation) in adult women with endometriosis.

METHODS: Data was collected in a sample composed of N = 210 Portuguese cisgender women with endometriosis in a three-wave online assessment spanning 12 months.

RESULTS: Using multilevel vector autoregressive network analysis, results showed significant temporal pathways in which pain intensity and pain impact predicted future increases in cognitive fusion, depression, and somatization, indicating a directional cascading effect of physical symptoms on psychological processes. Higher sexual distress over time was associated with decreases in cognitive fusion. Results also found strong positive associations among pain, anxiety, depression, and somatization at each time point, as well as between-subjects asymmetrical relationships, with anxiety and somatization more strongly predicting sexual distress than the reverse.

CONCLUSIONS: Overall, these findings highlight the importance of targeting transdiagnostic cognitive-emotional processes in interventions to improve pain, mental health, and sexual outcomes in women with endometriosis.

PMID:41968630 | DOI:10.1111/bjhp.70071