Background Reporting troublesome pain doubled the risk of the onset of depression in older people1. However the majority (84%) of those with troublesome pain remained free of depression. Social participation (SP) (i.e. recreational and functional activities involving interaction with others) has been linked to good mental health. Whether SP (and its associated pathways; social support (SS), eudaimonic wellbeing (EW; a sense of purpose and meaningfulness in life) and physical activity (PA)) is associated with maintaining mental health in older adults with troublesome pain is not known.
Objectives To test the hypothesis that among older people with troublesome pain higher levels of SP explain why some older people maintain good mental health, and if any role of SP remains once that through SS, PA and EW is accounted for.
Methods Data were from a nationally representative population-based prospective (baseline, 2 and 4 year follow up) cohort study of community-dwelling people aged ≥50 years; the English Longitudinal Study of Ageing (ELSA; n=2654). At baseline participants were asked “are you often troubled with pain?” (response options yes/no). Mental health was classified at baseline and 4 years using the 8-item Centre for Epidemiologic Studies Depression scale (CESD-8) with scores <4 indicating “good mental health”. SP at 2 years was defined using a multidimensional latent class model and coded as low or high participation. Path analysis assessed the total, direct and indirect (via SP) effects of pain at baseline on CESD-8 score at 4 year follow-up adjusted for age, gender, socioeconomic status, baseline CESD-8, self-rated health and limiting illness. In a multiple parallel pathways analysis EW (derived from CASP-19), SS and PA (using established ELSA measures) were then entered into the model. Not being troubled by pain was the referent category and results were expressed as odds ratios (OR) with 95% confidence intervals (95% CI).
Results 1475 (55.6%) were female, median age 62 years (interquartile range: 57–69) and 863 (32.5%) reported being often troubled by pain at baseline. Having pain at baseline was associated with a 70% decreased odds of good mental health (total effect OR 0.30; 95% CI (0.23, 0.38)). Among those with pain at baseline those with high SP at 2 years were 3 times more likely to have good mental health at 4 years (2.97; (2.29, 3.86)). After adjusting for confounders there was no indirect effect for SP (1.00; (0.98, 1.01)). In a multiple parallel pathways analysis there was a strong indirect effect for EW (0.53; (0.36, 0.73)) and no indirect effect through PA or SS.
Conclusions In older people with pain high EW was associated with good mental health 4 years later. Interventions that aim to increase EW may improve mental health outcomes in older people with pain.
Arola H-M et al. E J Pain 2010;14:966–971.
Disclosure of Interest None declared