Pain, Racial Discrimination, and Depressive Symptoms among African American Women

Abstract

African American women with osteoarthritis (OA) are at high risk of experiencing pain. They report more pain than non-Hispanic White women and men of other racial/ethnic groups. This pain can limit independence and diminish their quality of life. Despite the detrimental effects that pain can have on older African American women with OA, there is a dearth of literature examining factors beyond the OA pathology that are associated with pain outcomes within this population. The purpose of this study was to examine the relationships between racial discrimination and depressive symptoms with pain intensity in African American women with OA. The sample comprised of 120 African American women, aged 50-80 years, with OA, from Texas and New Mexico. The women completed survey booklets to answer study questionnaires. We used multiple linear regression to test associations between racial discrimination, depressive symptoms, and pain intensity. We tested whether depressive symptoms mediated the relationship between racial discrimination and pain intensity by using bootstrapping. Results indicated that racial discrimination was significantly associated with pain intensity and that this relationship was mediated by depressive symptoms, even after controlling for body mass index, years of education, and length of time with OA. Both depressive symptoms and racial discrimination may be modifiable. If these modifiable factors are addressed in this population, there may be decreased pain in middle-aged and older African American women.

“We get double slammed!”: Healthcare experiences of perceived discrimination among low-income African-American women

“…This differential treatment is reported in the literature as resulting in under-treatment of pain particularly for AA women. 50 , 51 …”

Psychological Interventions for the Treatment of Chronic Pain in Adults

“…Discrimination is associated with increased psychological distress, which is, in turn, associated with the development of chronic pain (Brown et al, 2018). Perceived discrimination has been linked to increased bodily pain among Black and Chinese Americans ( Burgess et al, 2009;Dugan et al, 2017) and to increased pain intensity among Black women with osteoarthritis (Taylor et al, 2018). Indeed, perceived discrimination was shown to be among the strongest predictors of back pain among people who identified as Black in a national sample (Edwards, 2008).…”

Greater mechanical temporal summation of pain in Latinx-Americans and the role of adverse life experiences

“… 49 Studies show that perceived racial/ethnic discrimination predicts greater clinical pain severity and laboratory pain sensitivity for African Americans. 14 , 25 , 54 , 86 Perceived racial discrimination likewise predicts greater laboratory pain sensitivity for African Americans but not NHWs. 39 Moreover, 2 recent studies find that discrimination predicts greater clinical pain severity among Latinx-Americans.…”

“…Latinx-Americans also experience unique, pervasive adverse life experiences that may relate with pain disparities, such as racial/ethnic discrimination. 14 , 39 , 86 Ethnic discrimination among Latinx-Americans in the United States is a common phenomenon: 62% of U.S.-born Latinx-Americans report experiencing discrimination or being mistreated because of their ethnicity. 47 Latinx-Americans not only experience discrimination more than NHWs, they likewise appraise it as more stressful.…”