Family emotional climate, depressive symptoms, and pain prevalence: Testing mediation pathways among midlife and older Black Americans.

OBJECTIVE

Family relationship quality has been linked to pain outcomes, recently for aging Black adults, yet possible mechanisms of effect remain heretofore untested. Guided by the Biobehavioral Family Model, this study tested whether depressive symptoms mediate prospective associations between family emotional climate and pain prevalence, and whether associations are moderated by baseline chronic pain status.

METHODS

We tested hypothesized associations among Black American participants of the nationally representative Midlife in the United States study (second [2004-2006] and third [2013-2015] waves) who reported on pain prevalence (N = 471; 65.2 % women; μ[age] = 50.45), using mediation and moderated mediation models.

RESULTS

Greater family strain was linked to a greater likelihood of chronic pain 10 years later via greater depressive symptoms. Greater family support was associated with a decreased likelihood of chronic pain via decreased depressive symptoms. Baseline chronic pain status moderated this indirect effect via its moderation of the direct link between family support and depressive symptoms, such that this effect was significantly stronger for individuals reporting baseline chronic pain.

CONCLUSION

Depression is well-supported as a chronic pain antecedent. This study provides initial evidence it may also serve as a mutable mechanism linking family emotional climate to pain for aging Black Americans. Primary care-based assessments of family emotional climate to intervene on family strain while mitigating depressive symptoms which reflect chronic strain may be pain-protective. Interventions may also benefit from enhancing family support especially for patients experiencing chronic pain. Additional within-group, longitudinal research is needed to further support the tested mechanism.