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Family Strain, Depression, and Somatic Amplification in Adults with Chronic Pain

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Abstract

Background

The associations between family strain, depression, and chronic pain interference vary across individuals, suggesting moderated relations, and one possible moderator is somatic amplification. The current study examined a moderated mediation model that investigated (a) whether depression mediated the relation between non-spouse family strain and chronic pain interference and (b) whether somatic amplification moderated the association between depression and chronic pain interference.

Methods

Data came from 933 adults who participated in the National Survey of Midlife Development in the USA. Participants completed telephone interviews or self-report measures.

Results

The relationship between non-spouse family strain and chronic pain interference was mediated by depression, and this mediation depended on the degree of somatic amplification. Specifically, individuals who experienced more non-spouse family strain were more likely to experience depression and higher levels of chronic pain interference. Somatic amplification significantly moderated the effect of depression on chronic pain, such that individuals with higher levels of somatic amplification and depression were likely to experience higher levels of chronic pain interference. The indirect effect of non-spouse family strain on chronic pain through depression was significant for low, middle, and high levels of somatic amplification.

Conclusions

The presence of chronic pain has been associated with family dynamics changing, which may be linked with higher levels of non-spouse family strain. A negative family environment may be related to the development of depression, which may be associated with the severity and inability to cope with chronic pain. Somatic amplification may strengthen the association between depression and pain intensity.

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References

  1. Voerman JS, Vogel I, de Waart F, Westendorp T, Timman R, Busschbach JJV, et al. Bullying abuse and family conflict as risk factors for chronic pain among Dutch adolescents. Eur J Pain. 2015;19:1544–51. https://doi.org/10.1002/ejp.689.

    Article  CAS  PubMed  Google Scholar 

  2. Kaczynski K, Gambhir R, Caruso A, Lebel A. Depression as a mediator of the relation between family functioning and functional disability in youth with chronic headaches. Headache. 2016;56:491–500. https://doi.org/10.1111/head.12709.

    Article  PubMed  Google Scholar 

  3. Lewandowski AS, Palermo TM, Stinson J, Handley S, Chambers CT. Systematic review of family functioning in families of children and adolescents with chronic pain. J Pain. 2010;11:1027–38. https://doi.org/10.1016/j.jpain.2010.04.005.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kaasboll J, Ranoyen I, Nilsen W, Lydersen S, Indredavik MS. Associations between parental chronic pain and self-esteem, social competence, and family cohesion in adolescent girls and boys – family linkage data from the HUNT study. BMC Public Health. 2015;15:1–9. https://doi.org/10.1186/s12889-015-2164-9.

    Article  Google Scholar 

  5. Akbari F, Dehghani M, Khatibi A, Vervoort T. Incorporating family function into chronic pain disability: the role of catastrophizing. Pain Res Manag. 2016;2016:1–9. https://doi.org/10.1155/2016/6838596.

    Article  Google Scholar 

  6. Cano A, Johansen AB, Leonard MT, Hanawalt JD. What are the marital problems of patients with chronic pain? Curr Pain Headache Rep. 2005;9:96–100. https://doi.org/10.1007/s11916-005-0045-0.

    Article  PubMed  Google Scholar 

  7. Patterson JM, Garwick AW. The impact of chronic illness on families: a family systems perspective. Ann Behav Med. 1994;16:131–42.

    Google Scholar 

  8. West C, Usher K, Foster K, Stewart L. Chronic pain and the family: the experience of the partners of people living with chronic pain. J Clin Nurs. 2012;21:3352–60. https://doi.org/10.1111/j.1365-2702.2012.04215.x.

    Article  PubMed  Google Scholar 

  9. Ohman M, Soderberg S. The experiences of close relatives living with a person with serious chronic illness. Qual Health Res. 2004;14:396–410. https://doi.org/10.1177/1049732303261692.

    Article  PubMed  Google Scholar 

  10. Burns JW, Post KM, Smith DA, Porter LS, Buvanendran A, Fras AM, et al. Spouse criticism and hostility during marital interaction: effects on pain intensity and behaviors among individuals with chronic low back pain. Pain. 2017.

  11. Cano A, Gillis M, Heinz W, Geisser M, Foran H. Marital functioning, chronic pain, and psychological distress. Pain. 2004;107:99–106.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Cano A, Leong LE, Williams AM, May DK, Lutz JR. Correlates and consequences of the disclosure of pain-related distress to one’s spouse. Pain. 2012;153:2441–7.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Cano A, Weisberg JN, Gallagher RM. Marital satisfaction and pain severity mediate the association between negative spouse response to pain and depressive symptoms in a chronic pain patient sample. Pain Med. 2000;2000:35–43.

    Article  Google Scholar 

  14. Lam M, Lehman AJ, Puterman, et al. Spouse depression and disease course among persons with rheumatoid arthritis. Arthritis Rheumatol. 2009;61:1011–7.

    Article  Google Scholar 

  15. Flor H, Turk DC, Scholz OB. Impact of chronic pain on the spouse: marital, emotional and physical consequences. J Psychosom. 1987;31:63–71.

    Article  CAS  Google Scholar 

  16. Romano JM, Turner JA, Friedman LS, Bulcroft RA, Jensen MP, Hops H, et al. Sequential analysis of chronic pain behaviors and spouse responses. J Consult Clin Psychol. 1992;60:777–82.

    Article  CAS  PubMed  Google Scholar 

  17. Faucett JA, Levine JD. The contributions of interpersonal conflict to chronic pain in the presence or absence of organic pathology. Pain. 1991;44:35–43. https://doi.org/10.1016/0304-3959(91)90144-M.

    Article  CAS  PubMed  Google Scholar 

  18. Driscoll MA, Higgins DM, Seng EK, Buta E, Goulet JL, Heapy AA, et al. Trauma, social support, family conflict, and chronic pain in recent service veterans: does gender matter. Pain Med. 2015;16:1101–011. https://doi.org/10.1111/pme.12744.

    Article  PubMed  Google Scholar 

  19. Palermo TM, Valrie CR, Karlson CW. Family and parent influences on pediatric chronic pain: a developmental perspective. Am Psychol. 2014;69:142–52. https://doi.org/10.1037/a0035216.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Bair MJ, Robinson RL, Katon W, Kroenke K. Depression and pain comorbidity: a literature review. Arch Intern Med. 2003;163:2433–45. https://doi.org/10.1001/archinte.163.20.2433.

    Article  PubMed  Google Scholar 

  21. de Heer EW, Gerrits M, Beekman A, et al. The association of depression and anxiety with pain: a study from NESDA. PLoS One. 2014;9:1–11. https://doi.org/10.1371/journal.pone.0106907.

    Article  CAS  Google Scholar 

  22. Lamb S, Guralnik J, Buchner D, Ferrucci LM, Hochberg MC, Simonsick EM, et al. Factors that modify the association between knee pain and mobility limitation in older women: the women’s health and aging study. Ann Rheum Dis. 2000;59:331–7. https://doi.org/10.1136/ard.59.5.331.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Burton AK, Tillotson KM, Main CJ, Hollis S. Psychosocial predictors of outcome in acute and subchronic low back trouble. Spine. 1995;20:722–8. https://doi.org/10.1097/00007632-199503150-00014.

    Article  CAS  PubMed  Google Scholar 

  24. Betrus PA, Elmore SK, Hamilton PA. Women and somatization: unrecognized depression. Health Care Women Int. 1995;16:287–97. https://doi.org/10.1080/07399339509516182.

    Article  CAS  PubMed  Google Scholar 

  25. Yavuz BG, Aydinlar EI, Dikmen PY, Incesu C. Association between somatic amplification, anxiety, depression, stress and migraine. J Headache Pain. 2012;14:53. https://doi.org/10.1186/1129-2377-14-53.

    Article  Google Scholar 

  26. Bener A, Verjee M, Dafeeah EE, et al. Psychological factors: anxiety, depression, and somatization symptoms in low back pain patients. J Pain Res. 2013;6:96–101. https://doi.org/10.2147/JPR.S40740.

    Article  Google Scholar 

  27. Kosturek A, Gregory RJ, Sousou AJ, Trief P. Alexithymia and somatic amplification in chronic pain. Psychosomatics. 1988;39:399–404. https://doi.org/10.1016/S0033-3182(98)71298-8.

    Article  Google Scholar 

  28. Lavigne JV, Saps M, Bryant FB. Models of anxiety, depression, somatization, and coping as predictors of abdominal pain in a community sample of school-age children. J Pediatr Psychol. 2014;39:9–22. https://doi.org/10.1093/jpepsy/jst060.

    Article  PubMed  Google Scholar 

  29. Barsky AJ, Goodson JD, Lane RS, Cleary PD. The amplification of somatic symptoms. Psychosom Med. 1988;50:510–9. https://doi.org/10.1097/00006842-198809000-00007.

    Article  CAS  PubMed  Google Scholar 

  30. Kadam UT, Jordan K, Croft PR. Clinical comorbidity was specific to disease pathology, psychologic distress, and somatic symptom amplification. J Clin Epidemiol. 2005;58:909–17. https://doi.org/10.1016/j.jclinepi.2005.02.007.

    Article  PubMed  Google Scholar 

  31. Kallivayalil RA, Punnoose VP. Understanding and managing somatoform disorders: making sense of nonsense. Indian J Psychiatry. 2010;52:S240–5. https://doi.org/10.4103/0019-5545.69239.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Kashikar-Zuck S, Lynch AM, Slater S, Graham TB, Swain NF, Noll RB. Family factors, emotional functioning, and functional impairment in juvenile fibromyalgia syndrome. Arthritis Rheumatol. 2008;59:1392–8. https://doi.org/10.1002/art.24099.

    Article  Google Scholar 

  33. Ross CK, Lavigne JV, Hayford JR, Berry SL, Sinacore JM, Pachman P. Psychological factors affecting reported pain in juvenile rheumatoid arthritis. J Pediatr Psychol. 1993;18:561–73. https://doi.org/10.1093/jpepsy/18.5.561.

    Article  CAS  PubMed  Google Scholar 

  34. Gadermann AM, Alonso J, Vilagut G, Zaslavsky AM, Kessler RC. Comorbidity and disease burden in the National Comorbidity Survey Replication (NCS-R). Depress Anxiety. 2012;29:797–806. https://doi.org/10.1002/da.21924.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Miller LR, Cano A. Comorbid chronic pain and depression: who is at risk? J Pain. 2009;10:619–27. https://doi.org/10.1016/j.jpain.2008.12.007.

    Article  PubMed  Google Scholar 

  36. Brim OG, Ryff CD, Kessler RC, editors. How healthy are we?: a national study of well-being at midlife. Chicago: University of Chicago Press; 2004.

    Google Scholar 

  37. Radler BT, Ryff CD. Who participates? Accounting for longitudinal retention in the MIDUS national study of health and well-being. J Aging Health. 2010;22:307–31. https://doi.org/10.1177/0898264309358617.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Raichle KA, Osborne TL, Jensen MP, Cardenas D. (2006). The reliability and validity of pain interference measures in persons with spinal cord injury. J Pain. 2006;7:179–86. https://doi.org/10.1016/j.jpain.2005.10.007.

    Article  PubMed  Google Scholar 

  39. Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med Singap. 1994;23:129–38.

    CAS  PubMed  Google Scholar 

  40. Harding G, Schein JR, Nelson WW, Vallow S, Olson WH, Hewitt DJ, et al. Development and validation of a new instrument to evaluate the ease of use of patient-controlled analgesic modalities for postoperative patients. J Med Econ. 2010;13:42–54. https://doi.org/10.3111/13696990903484637.

    Article  PubMed  Google Scholar 

  41. Walen HR, Lachman ME. Social support and strain from partner, family, and friends: costs and benefits for men and women in adulthood. J Soc Pers Relat. 2000;17:5–30.

    Article  Google Scholar 

  42. Wittchen HU. Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res. 1994;28:57–84.

    Article  CAS  PubMed  Google Scholar 

  43. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and statistical manual of mental disorders, revised Third Edition. Washington, DC. American Psychiatric Association; 1987.

  44. American Psychiatric Association, Committee on Nomenclature and Statistics. Diagnostic and statistical manual of mental disorders, Fifth Edition. Washington, DC. American Psychiatric Association; 2013.

  45. Wang PS, Berglund P, Kessler RC. Recent care of common mental disorders in the United States. J Gen Intern Med. 2000;15:284–92. https://doi.org/10.1046/j.1525-1497.2000.9908044.x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. McWilliams LA, Goodwin RD, Cox BJ. Depression and anxiety associated with three pain conditions: results from a nationally representative sample. Pain. 2004;111:77–83. https://doi.org/10.1016/j.pain.2004.06.002.

    Article  PubMed  Google Scholar 

  47. Segel-Karpas D, Palgi Y, Shrira A. The reciprocal relationship between depression and physical morbidity: the role of subjective age. Health Psychol. 2017;36:848–51. https://doi.org/10.1037/hea0000542.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York, NY: Guilford Press; 2013.

    Google Scholar 

  49. Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. Hillsdale, NJ: Lawrence Earlbaum Associates; 1988.

    Google Scholar 

  50. Eberly L, Richter D, Comerci G, Ocksrider J, Mercer D, Mlady G, et al. Psychosocial and demographic factors influencing pain scores of patients with knee osteoarthritis. PLoS One. 2018;13:e0195075. https://doi.org/10.1371/journal.pone.0195075.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Creamer P, Lethbridge-Cejku M, Hochberg MC. Determinants of pain severity in knee osteoarthritis: effect of demographic and psychosocial variables using 3 pain measures. J Rheumatol. 1999;26(8):1785–92.

    CAS  PubMed  Google Scholar 

  52. Davis MA, Ettinger WH, Neuhaus JM, Barclay JD, Segal MR. Correlates of knee pain among US adults with and without radiographic knee osteoarthritis. J Rheumatol. 1992;19(12):1943–9.

    CAS  PubMed  Google Scholar 

  53. Martire LM, Schulz R. Involving family in psychosocial interventions for chronic illness. Curr Dir Psychol Sci. 2007;16:90–4.

    Article  Google Scholar 

  54. Martire LM, Schulz R, Keefe FJ, Starz TW, Osial TA Jr, Dew MA, et al. Feasibility of a dyadic intervention for management of osteoarthritis: a pilot study with older patients and their spousal caregivers. Aging Ment Health. 2003;7:53–60.

    Article  CAS  PubMed  Google Scholar 

  55. Block AR, Kremer EF, Gaylor M. Behavioral treatment of chronic pain: the spouse as a discriminant cue for pain behavior. Pain. 1980;9:243–52.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Dianna Boone.

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Boone, D., Kim, S.Y. Family Strain, Depression, and Somatic Amplification in Adults with Chronic Pain. Int.J. Behav. Med. 26, 427–436 (2019). https://doi.org/10.1007/s12529-019-09799-y

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