1
|
Kabangu JLK, Bah MG, Enogela EM, Judd SE, Hobson JM, Levitan EB, Eden SV. The Association Between Experienced Discrimination and Pain in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-02130-w. [PMID: 39158830 DOI: 10.1007/s40615-024-02130-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Revised: 08/03/2024] [Accepted: 08/06/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND The relationship between experienced discrimination and its effects on pain interference and management among racial disparities is not well explored. This research investigated these associations among Black and White U.S. adults. METHODS The analysis involved 9369 Black and White adults in the REasons for Geographic and Racial Differences in Stroke (REGARDS), assessing experiences of discrimination, pain interference (SF-12), and pain treatment, incorporating factors like demographics, comorbidities, and stress. RESULTS Black participants experiencing moderate discrimination were found to have a 41% increased likelihood of pain interference (aOR 1.41, 95% CI 1.02-1.95), similaritythose facing high levels of discrimination also showed a 41% increase (aOR 1.41, 95% CI 1.06-1.86) compared to those without such experiences. White individuals reporting moderate discrimination also faced a heightened risk, with a 21% greater chance of pain interference (aOR 1.21, 95% CI 1.01-1.45). Notably, the presence of moderate discrimination among Black participants correlated with a 12% reduced probability of receiving pain treatment (aOR 0.88, 95% CI 0.56-1.37). Furthermore, Black, and White individuals who reported discrimination when seeking employment had a 33% (aOR 0.67, 95% CI 0.45-0.98) and 32% (aOR 0.68, 95% CI 0.48-0.96) lower likelihood, respectively, of receiving treated pain. CONCLUSION The study elucidates how discrimination exacerbates pain interference and restricts access to treatment, affecting Black and White individuals differently. These findings underscore an urgent need for strategies to counteract discrimination's negative effects on healthcare outcomes. Addressing these disparities is crucial for advancing health equity and improving the overall quality of care.
Collapse
Affiliation(s)
- Jean-Luc K Kabangu
- Department of Neurological Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA.
| | - Momodou G Bah
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Ene M Enogela
- Department of Epidemiology, School of Public Health, University of Alabama Birmingham, Birmingham, AL, USA
| | - Suzanne E Judd
- Department of Biostatistics, School of Public Health, University of Alabama Birmingham, Birmingham, AL, USA
| | - Joanna M Hobson
- Department of Psychology, College of Arts and Science, University of Alabama Birmingham, Birmingham, AL, USA
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama Birmingham, Birmingham, AL, USA
| | - Sonia V Eden
- Semmes-Murphey Clinic, Memphis, TN, USA
- Department of Neurological Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| |
Collapse
|
2
|
Olson K, Eccleston C. Reconsidering the role of weight loss in treatment for chronic pain: Knee Osteoarthritis as an exemplar. THE JOURNAL OF PAIN 2024:104647. [PMID: 39103008 DOI: 10.1016/j.jpain.2024.104647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/26/2024] [Accepted: 07/28/2024] [Indexed: 08/07/2024]
Abstract
Chronic pain is prevalent among individuals with higher body weight and associated with greater impairment. As a result, weight loss is a common recommendation for pain management among those with higher body weight. Body weight is an appealing target because it is modifiable and evidence-based treatments to produce weight loss are well-established. In the last two decades there has been a growing line of scientific work investigating the application of weight loss to individuals with chronic pain. This represents an important step to integrate the conceptualization of pain and body weight and there is preliminary work suggesting treatment effects are enhanced when weight loss treatment is combined with pain coping skills. However, weight loss outcomes are variable and difficult to sustain, and access to evidence-based treatment is limited. These concerns are set against the backdrop of growing public and academic concern about the weight-centric approach to healthcare that dominates western medicine. This is a timely moment to reconsider the conceptualization of weight and pain, and the role of weight loss in chronic pain treatment. Using osteoarthritis as an exemplar, we review the evidence for and clinical uptake of weight loss as a chronic pain management strategy and conclude with key areas for consideration to advance the scientif ic understanding of these comorbid conditions and how to optimize pain management for individuals of higher body weight. PERSPECTIVE: This focus article critically considers the role of weight loss in management of chronic pain among individuals of higher body. Using knee osteoarthritis as an exemplar, the evidence and clinical uptake of weight loss for pain management is reviewed. Limitations are considered to guide future research and clinical care.
Collapse
Affiliation(s)
- KayLoni Olson
- Weight Control and Diabetes Research Center, Miriam Hospital; Department of Psychiatry and Human Behavior, Brown Medical School.
| | - Christopher Eccleston
- Research Department for Health, University of Bath; Centre for Pain Research, University of Bath
| |
Collapse
|
3
|
Hickling LM, Allani S, Cella M, Scott W. A systematic review with meta-analyses of the association between stigma and chronic pain outcomes. Pain 2024; 165:1689-1701. [PMID: 38776178 PMCID: PMC11247453 DOI: 10.1097/j.pain.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 05/24/2024]
Abstract
ABSTRACT Stigma is common in people experiencing chronic pain and there are indications that it may adversely affect pain outcomes. However, to date, there is no systematic review exploring the impact of stigma on chronic pain-related outcomes. This systematic review and meta-analysis aimed to examine the association between stigma and key chronic pain outcomes and differences in stigma between pain conditions. Seven databases were searched for studies reporting a measure of association between stigma and at least one pain outcome in adults with chronic pain. Studies were screened by 2 independent researchers. Nineteen studies met eligibility criteria and data were extracted, quality-assessed, and narratively synthesised and meta-analysed where possible. Meta-analyses of bivariate cross-sectional correlations demonstrated significant positive correlations between stigma and pain intensity, disability, and depression, with small to moderate effects. Data from 2 prospective studies and those only reporting multivariate analyses that were not included in meta-analyses further supported these findings. There was some evidence that individuals who experience pain conditions with less clear pathophysiology may report greater stigma, although more research is needed. The review highlights that there is a growing number of studies on stigma in the pain field showing an adverse association between stigma and chronic pain outcomes.
Collapse
Affiliation(s)
- Lauren M. Hickling
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Selsebil Allani
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
| | - Matteo Cella
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Whitney Scott
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
4
|
Weiss KE, Li R, Chen D, Palermo TM, Scheurich JA, Groenewald CB. Sexual Orientation/Gender Identity Discrimination and Chronic Pain in Children: A National Study. Am J Prev Med 2024; 67:175-183. [PMID: 38508423 DOI: 10.1016/j.amepre.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION This study provides national estimates of parental perceived child sexual orientation or gender minority (SGM) discrimination and examines associations between SGM discrimination and chronic pain in children. METHODS Cross-sectional analysis of the 2020 and 2021 National Survey of Children's Health (N=47,213). Caregivers of children ages 6-17 years old reported whether their child had ever been treated or judged unfairly (i.e., discrimination) because of their SGM identity. Chronic pain in children was defined as frequent or chronic difficulty with repeated or chronic physical pain during the past 12 months, as reported by caregivers. Weighted prevalence estimates for discrimination were calculated for the whole sample and sociodemographic subgroups. Associations between SGM discrimination and chronic pain were estimated using multivariable Poisson regression models adjusting for sociodemographic factors. Analyses were conducted 2022-2023. RESULTS Within this nationally representative sample, parents reported 1.4% (95% CI 1.2%-1.6%) of children have experienced SGM-related discrimination. The prevalence was higher among adolescents, females at birth, and those living in suburban areas. Children who experienced discrimination had a higher prevalence of chronic pain (20.2%) compared to those who did not (7.0%, p<0.0001), with an adjusted prevalence rate ratio of 2.0 (95% CI 1.5-2.5, p<0.0001). CONCLUSIONS Based on parent report, about 0.6 million children in the U.S. have experienced SGM-based discrimination; these children are twice as likely to have chronic pain. Findings highlight the importance of assessment and intervention for chronic pain in children who may experience marginalization and discrimination due to their sexual orientation and gender identity.
Collapse
Affiliation(s)
- Karen E Weiss
- Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota.
| | - Rui Li
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington
| | - Diane Chen
- Potocsnak Family Division and Adolescent and Young Adult Medicine, & Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Departments of Psychiatry & Behavioral Sciences, and Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Tonya M Palermo
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, Washington; Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Jennifer A Scheurich
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri; University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Cornelius B Groenewald
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
5
|
Kristensen CB, Chilcot J, Jackson SE, Steptoe A, Hackett RA. The impact of a diabetes diagnosis on health and well-being: Findings from the English Longitudinal Study of Ageing. J Diabetes 2024; 16:e13518. [PMID: 38112231 PMCID: PMC11212344 DOI: 10.1111/1753-0407.13518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Poorer health and well-being are associated with diabetes risk. However, little is known about the trajectory of health and well-being from before to after diabetes diagnosis. We compared depressive symptoms, quality of life, self-rated health, and loneliness at three time points (prediagnosis, diagnosis, 2-4 years post diagnosis) in individuals who developed diabetes and a comparison group. METHODS Health and well-being measures were self-reported by 3474 participants from the English Longitudinal Study of Ageing. Repeated measures analysis of variance and generalized estimating equations were used to investigate differences by group, time, and group-by-time interactions. RESULTS A total of 473 (13.6%) participants developed diabetes. The diabetes group reported greater depressive symptoms (W2(1) = 20.67, p < .001) and lower quality of life (F = 1, 2535 = 10.30, p = .001) and were more likely to rate their health as fair/poor (W2(1) = 67.11, p < .001) across time points, adjusting for age, sex, and wealth. They also reported greater loneliness (F = 1, 2693 = 9.70, p = .002) in unadjusted analyses. However, this was attenuated to the null in adjusted analyses. The group-by-time interaction was significant for quality of life (F = 1.97, 5003.58 = 5.60, p = .004) and self-rated health (W2(2) = 11.69, p = .003), with a greater decline in these measures over time in the diabetes group in adjusted analyses. CONCLUSION People who received a diabetes diagnosis had greater depressive symptoms, lower quality of life, and poorer self-rated health than those who did not develop diabetes. Quality of life and self-rated health deteriorated more rapidly following a diagnosis. Screening for these factors around the time of diagnosis could allow for interventions to improve the health and well-being of those with diabetes.
Collapse
Affiliation(s)
- Camilla Böhme Kristensen
- Health Psychology Section, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Joseph Chilcot
- Health Psychology Section, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Sarah E. Jackson
- Department of Behavioural Science and Health, Institute of Epidemiology and Health CareUniversity College LondonLondonUK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, Institute of Epidemiology and Health CareUniversity College LondonLondonUK
| | - Ruth A. Hackett
- Health Psychology Section, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| |
Collapse
|
6
|
Werneck AO, Stubbs B. Bidirectional relationship between chronic pain and depressive symptoms in middle-aged and older adults. Gen Hosp Psychiatry 2024; 89:49-54. [PMID: 38761582 DOI: 10.1016/j.genhosppsych.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To assess the bidirectional association between chronic pain and depressive symptoms among middle-aged and older adults from two prospective cohort studies. METHODS We used prospective data (12y of follow-up) from the English Longitudinal Study of Ageing (n = 9149, 5018 women, 65.0 ± 10.2y) and the Health and Retirement Study (n = 16,883, 9810 women, 66.9 ± 10.3y), including data from seven waves of each cohort between 2006 and 2018/2019. Depressive symptoms were assessed using the Centre of Epidemiological Studies Depression scale, while chronic pain was estimated using questions about the frequency of being troubled with pain. We used random-intercept cross-lagged panel models to assess the bidirectional association between pain and depressive symptoms, adjusting for potential confounders. RESULTS There was a cross-lagged effect of chronic pain on depressive symptoms (ELSA: β: 0.038; 95%CI: 0.011-0.066. Standardized coefficient (B): 0.021. SHARE β: 0.044; 95%CI: 0.023-0.065. B: 0.023-0.024) as well as depressive symptoms on pain (ELSA: β: 0.010; 95%CI: 0.002-0.018. B: 0.017-0.019. SHARE 0.011; 95%CI: 0.005-0.017. B: 0.020-0.021). Moreover, there were auto-regressive effects of both chronic pain (ELSA: β: 0.149; 95%CI: 0.128-0.171. SHARE β: 0.129; 95%CI: 0.112-0.145) and depressive symptoms (ELSA: β: 0.149; 95%CI: 0.130-0.168. SHARE β: 0.169; 95%CI: 0.154-0.184). CONCLUSION We identified a modest bidirectional association between depressive symptoms and chronic pain, using two large prospective ageing cohorts.
Collapse
Affiliation(s)
- André O Werneck
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Center for Epidemiological Research in Nutrition and Health, Department of Nutrition, School of Public Health, Universidade de São Paulo (USP), São Paulo, SP, Brazil
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
| |
Collapse
|
7
|
Hackett RA, Hunter MS, Jackson SE. The relationship between gender discrimination and wellbeing in middle-aged and older women. PLoS One 2024; 19:e0299381. [PMID: 38507365 PMCID: PMC10954130 DOI: 10.1371/journal.pone.0299381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/07/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Emerging evidence suggests that perceived gender discrimination negatively impacts mental wellbeing in young women. PURPOSE This study explored whether a similar relationship exists in middle-aged and older women. METHODS A total of 3081 women (aged ≥52 years) from the English Longitudinal Study of Ageing provided data on perceived gender discrimination in 2010/11. Depressive symptoms, loneliness, quality of life and life satisfaction were assessed in 2010/11 and in 2016/17. RESULTS Perceived gender discrimination was reported by 282 (9.2%) participants. Cross-sectionally, women who perceived gender discrimination reported more depressive symptoms (β = 0.34, 95% CI 0.11 to 0.57) and had higher loneliness scores (β = 0.14, 95% CI 0.08 to 0.20) than women who did not perceive gender discrimination. They also reported significantly lower quality of life (β = -2.50, 95% CI -3.49 to -1.51) and life satisfaction (β = -1.07, 95% CI -1.81 to -0.33). Prospectively, perceived gender discrimination was associated with greater loneliness scores (β = 0.08, 95% CI 0.02 to 0.14), as well as lower ratings of quality of life (β = -0.98, 95% CI -0.09 to -1.86), and life satisfaction (β = -1.04, 95% CI -0.34 to -1.74), independent of baseline values. CONCLUSIONS Middle-aged and older women who perceive gender discrimination report poorer mental wellbeing than those who do not perceive discrimination. Further, this type of discrimination may be predictive of declining mental wellbeing over time. These findings highlight the need for interventions to target gender-based discrimination to improve the wellbeing of women at mid- and older age.
Collapse
Affiliation(s)
- Ruth A. Hackett
- Institute of Psychiatry, Psychology and Neuroscience, Health Psychology Section, King’s College London, London, United Kingdom
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Myra S. Hunter
- Institute of Psychiatry, Psychology and Neuroscience, Health Psychology Section, King’s College London, London, United Kingdom
| | - Sarah E. Jackson
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| |
Collapse
|
8
|
Anderson M, McCracken LM, Scott W. An investigation of the associations between stigma, self-compassion, and pain outcomes during treatment based on Acceptance and Commitment Therapy for chronic pain. Front Psychol 2024; 15:1322723. [PMID: 38379625 PMCID: PMC10876841 DOI: 10.3389/fpsyg.2024.1322723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/12/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Stigma adversely affects people with chronic pain. The qualities within self-compassion may be particularly useful for buffering the impact of stigma on people with pain. In the context of an Acceptance and Commitment Therapy-based (ACT) treatment for chronic pain, this study investigated the association between changes in stigma and self-compassion and pain outcomes, and the potential moderating role of self-compassion on the association between stigma and pain outcomes. Materials and methods Five-hundred and nineteen patients completed standardized self-report questionnaires of stigma, self-compassion, psychological flexibility, pain intensity and interference, work and social adjustment, and depression symptoms at the start of an interdisciplinary ACT-based treatment for chronic pain. The same measures were completed at post-treatment (n = 431). Results The results indicated that key pain outcomes and self-compassion significantly improved during treatment, but stigma did not. Changes in stigma and self-compassion were significantly negatively correlated and changes in these variables were associated with improvements in treatment outcomes. There were significant main effects of stigma and self-compassion for many of the pre- and post-treatment regression models when psychological flexibility was not controlled for, but self-compassion did not moderate the association between stigma and pain outcomes. Stigma remained significant when psychological flexibility variables were controlled for, while self-compassion did not. Discussion The findings add to our conceptual understanding of the inter-relationships between stigma, self-compassion, and psychological flexibility and can contribute to treatment advancements to optimally target these variables.
Collapse
Affiliation(s)
- Madeleine Anderson
- INPUT Pain Unit, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Whitney Scott
- INPUT Pain Unit, Guy’s and St. Thomas’ Hospital NHS Foundation Trust, London, United Kingdom
- Health Psychology Section, Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, United Kingdom
| |
Collapse
|
9
|
de C Williams AC. Pain: Behavioural expression and response in an evolutionary framework. Evol Med Public Health 2023; 11:429-437. [PMID: 38022798 PMCID: PMC10656790 DOI: 10.1093/emph/eoad038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/25/2023] [Indexed: 12/01/2023] Open
Abstract
An evolutionary perspective offers insights into the major public health problem of chronic (persistent) pain; behaviours associated with it perpetuate both pain and disability. Pain is motivating, and pain-related behaviours promote recovery by immediate active or passive defence; subsequent protection of wounds; suppression of competing responses; energy conservation; vigilance to threat; and learned avoidance of associated cues. When these persist beyond healing, as in chronic pain, they are disabling. In mammals, facial and bodily expression of pain is visible and identifiable by others, while social context, including conspecifics' responses, modulate pain. Studies of responses to pain emphasize onlooker empathy, but people with chronic pain report feeling disbelieved and stigmatized. Observers frequently discount others' pain, best understood in terms of cheater detection-alertness to free riders that underpins the capacity for prosocial behaviours. These dynamics occur both in everyday life and in clinical encounters, providing an account of the adaptiveness of pain-related behaviours.
Collapse
Affiliation(s)
- Amanda C de C Williams
- Research Department of Clinical, Educational & Health Psychology, University College London, Gower St, London WC1E 6BT, UK
| |
Collapse
|
10
|
Hackett RA, Jackson SE, Corker E, Steptoe A. The role of stress and health behaviour in linking weight discrimination and health: a secondary data analysis in England. BMJ Open 2023; 13:e072043. [PMID: 37709322 PMCID: PMC10503332 DOI: 10.1136/bmjopen-2023-072043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVE To examine the role of stress and health-risk behaviours in relationships between weight discrimination and health and well-being. DESIGN Secondary data analysis of an observational cohort study. SETTING The English Longitudinal Study of Ageing. PARTICIPANTS Data were from 4341 adults (≥50 years) with overweight/obesity. PRIMARY OUTCOME MEASURES We tested associations between perceived weight discrimination at baseline (2010/2011) and self-rated health, limiting long-standing illness, depressive symptoms, quality of life and life satisfaction over 4-year follow-up (2010/2011; 2014/2015). Potential mediation by stress exposure (hair cortisol) and health-risk behaviours (smoking, physical inactivity, alcohol consumption) was assessed. RESULTS Cross-sectionally, perceived weight discrimination was associated with higher odds of fair/poor self-rated health (OR=2.05 (95% CI 1.49 to 2.82)), limiting long-standing illness (OR=1.76 (95% CI 1.29 to 2.41)) and depressive symptoms (OR=2.01 (95% CI 1.41 to 2.85)) and lower quality of life (B=-5.82 (95% CI -7.01 to -4.62)) and life satisfaction (B=-2.36 (95% CI -3.25 to -1.47)). Prospectively, weight discrimination was associated with higher odds of fair/poor self-rated health (OR=1.63 (95% CI 1.10 to 2.40)) and depressive symptoms (OR=2.37 (95% CI 1.57 to 3.60)) adjusting for baseline status. Those who reported discrimination had higher hair cortisol concentrations (B=0.14 (95% CI 0.03 to 0.25)) and higher odds of physical inactivity (OR=1.90 (95% CI 1.18 to 3.05)). These variables did not significantly mediate associations between discrimination and health outcomes. CONCLUSIONS Weight discrimination is associated with poor health and well-being. While this discrimination is associated with stress exposure and physical inactivity, these variables explain little of the association between discrimination and poorer outcomes.
Collapse
Affiliation(s)
- Ruth A Hackett
- Health Psychology Section, Department of Psychology, King's College London, London, UK
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
| | - Elizabeth Corker
- Clinical, Educational and Health Psychology, University College London, London, UK
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Andrew Steptoe
- Department of Behavioural Science and Health, University College London, London, UK
| |
Collapse
|
11
|
Abbas M, Reich AJ, Wang Y, Hu FY, Bollens-Lund E, Kelley AS, Cooper Z. The burden of pre-admission pain, depression, and caregiving on palliative care needs for seriously ill trauma patients. J Am Geriatr Soc 2023; 71:2229-2238. [PMID: 36805543 PMCID: PMC10363197 DOI: 10.1111/jgs.18289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 01/25/2023] [Accepted: 01/26/2023] [Indexed: 02/23/2023]
Abstract
INTRODUCTION Increasing numbers of individuals admitted to hospitals for trauma are older adults, many of whom also have underlying serious illnesses. Older adults with serious illness benefit from palliative care, but the palliative care needs of seriously ill older adults with trauma have not been elucidated. We hypothesize that older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours before trauma admission. METHODS Using Health and Retirement Study data (2008-2018) linked to Medicare claims, we identified patients 66 years or older who met an established definition of serious illness in surgery and were admitted with trauma. Descriptive analyses were performed for baseline patient characteristics, pre-admission pain (dichotomized as none/mild vs. moderate/severe), depression (dichotomized as no, Center for Epidemiologic Studies Depression scale [CES-D] < 3 vs. yes, CES-D ≥ 3), and unpaid caregiving hours (dichotomized as low (<30 h/month), high (≥30 h/month)). RESULTS We identified 1741 patients, 67.4% were female and 86.8% White. Mean age was 83 (SD 7.5), and 60.3% had ≥4 comorbidities. The majority (62.9%) were admitted due to falls, 33.5% had isolated hip fracture. The prevalence of baseline moderate/severe pain and depression were 38.1% and 42.6%, respectively. Among the cohort, 42.2% had unpaid caregiving, of those 27.7% had ≥30 h/week of unpaid caregiving hours. CONCLUSIONS Prior to trauma admission, older adults with serious illness have a high prevalence of pain, depression, and unpaid caregiving hours. These findings may inform targeted palliative care interventions to reduce symptom burden and post-discharge healthcare utilization.
Collapse
Affiliation(s)
- Muhammad Abbas
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Amanda Jane Reich
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Yihan Wang
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Frances Y Hu
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Evan Bollens-Lund
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Zara Cooper
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
12
|
Roberts-West L, Gravatt A, Guest N, Hunt A, Siddique L, Serbic D. A Comparison of Social Exclusion Towards People with Depression or Chronic Back Pain. Br J Pain 2023; 17:267-280. [PMID: 37342396 PMCID: PMC10278445 DOI: 10.1177/20494637221148337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Objectives Research comparing mental and physical health stigma is scarce. The aim of this study was to compare social exclusion towards hypothetical males and females with depression or chronic back pain. Furthermore, the study investigated whether social exclusion is associated with participant's empathy and personality traits, while controlling for their sex, age and personal exposure to mental/physical chronic health conditions. Design This study employed a cross-sectional questionnaire design. Methods Participants (N = 253) completed an online vignette-based questionnaire and were randomly allocated to either a depression or chronic back pain study condition. Measures of social exclusion through respondents' willingness to interact with hypothetical individuals, empathy and the Big Five personality traits were completed. Results Willingness to interact scores did not significantly differ depending on the diagnosis or sex of the hypothetical person in the vignette. For depression, higher levels of conscientiousness significantly predicted less willingness to interact. Whilst being a female participant and having higher empathy significantly predicted greater willingness to interact. For chronic back pain, higher empathy significantly predicted greater willingness to interact, with no significant predictors found from the Big Five personality traits. Conclusion Findings indicate that females and males with depression or chronic back pain face similar levels of social exclusion, with empathy being a core variable driving social exclusion behaviours. These findings enhance our understanding of potential variables driving social exclusion, in-turn informing campaign development to reduce public stigma towards depression and chronic back pain.
Collapse
Affiliation(s)
- Lucy Roberts-West
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Amy Gravatt
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Natasha Guest
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Ashley Hunt
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Laraib Siddique
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Danijela Serbic
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| |
Collapse
|
13
|
Ashton-James CE, Anderson SR, Hirsh AT. Understanding the contribution of racially and ethnically discordant interactions to pain disparities: proximal mechanisms and potential solutions. Pain 2023; 164:223-229. [PMID: 35594518 PMCID: PMC9675882 DOI: 10.1097/j.pain.0000000000002698] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 05/12/2022] [Indexed: 02/06/2023]
Affiliation(s)
- Claire E Ashton-James
- Sydney Medical School, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Steven R Anderson
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Adam T Hirsh
- Department of Psychology, Indiana University-Purdue University Indianapolis, Indianapolis, IN, United States
| |
Collapse
|
14
|
Amirova A, Rimes KA, Hackett RA. Perceived discrimination in middle-aged and older adults: Comparison between England and the United States. Front Public Health 2022; 10:975776. [PMID: 36438296 PMCID: PMC9685535 DOI: 10.3389/fpubh.2022.975776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 10/25/2022] [Indexed: 11/11/2022] Open
Abstract
Objectives This study examined differences in perceived discrimination across multiple characteristics in England and the United States (US), in middle- and older-aged adults. Methods Using data from the English Longitudinal Study of Aging (N = 8,671) and the US-based Health and Retirement Study (N = 7,927), we assessed cross-national differences in perceived discrimination attributed to disability, financial status, sex, race, sexual orientation, and weight. We also compared how perceived discrimination varied with socioeconomic position (SEP) based on wealth. Results Perceived discrimination due to financial status was more common in England (6.65%) than in the US (2.14%) adjusting for age, sex, and wealth [Odds Ratio (OR) = 1.09, 95% CI (1.07; 1.10)]. This affected people of low but not high SEP. Sexual orientation discrimination was more common in England [0.72 vs. 0.15%, OR = 4.61, 95% CI (2.48; 8.57)]. Sex-based perceived discrimination was more prevalent in the US (12.42%) than England (9.07%) adjusting for age and wealth [OR = 0.87, 95% CI (0.86; 0.89)]. Cross-national differences in sex discrimination did not vary with SEP. Racism was the most common type of perceived discrimination reported in both samples (England: 17.84%, US: 19.80%), with no significant cross-national differences after adjustment for sex. Discussion Perceived discrimination attributed to financial status and sexual orientation were more prevalent in England, while more women perceived sex discrimination in the US. This study suggests that country-specific and socioeconomic factors affect the prevalence of perceived discrimination. This may be relevant when targeting interventions aimed at reducing perceived discrimination.
Collapse
|
15
|
Onwumere J, Stubbs B, Stirling M, Shiers D, Gaughran F, Rice AS, C de C Williams A, Scott W. Pain management in people with severe mental illness: an agenda for progress. Pain 2022; 163:1653-1660. [PMID: 35297819 PMCID: PMC9393797 DOI: 10.1097/j.pain.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 01/31/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022]
Abstract
Supplemental Digital Content is Available in the Text.
Collapse
Affiliation(s)
- Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, United Kingdom
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Mary Stirling
- Involvement Register Member of South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Service User Member of Oxleas NHS Foundation Trust, London, United Kingdom
- Mind and Body Expert Advisory Group, King's Health Partners, London, United Kingdom
- Patient Governor of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - David Shiers
- Psychosis Research Unit, Greater Manchester Mental Health NHS Trust, Manchester, United Kingdom
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Primary Care and Health Sciences, Keele University, Keele, United Kingdom
| | - Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, United Kingdom
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Andrew S.C. Rice
- Pain Research Group, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Amanda C de C Williams
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, United Kingdom
| | - Whitney Scott
- Health Psychology Section, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
16
|
Identifying the Presence of Ethics Concepts in Chronic Pain Research: A Scoping Review of Neuroscience Journals. NEUROETHICS-NETH 2022. [DOI: 10.1007/s12152-022-09499-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
17
|
Discrimination as one of the social plights facing people with pain. Pain 2022; 163:e149-e150. [DOI: 10.1097/j.pain.0000000000002369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
|