Pain Is Widespread and Predicts Poor Mental Health Among Older Adults in Rural Malawi

Abstract

Background and Objectives Pain is common among older persons and has been documented as an important predictor of disability, health, and economic outcomes. Evidence about its prevalence and relationship to well-being is scarce in rural sub-Saharan Africa (SSA) where work is frequently physically demanding, and pain prevention or treatment options are limited. We investigate the prevalence of pain and its association with mental health and subjective well-being in a population-based study of older adults in rural Malawi. Research Design and Methods We estimate the prevalence, severity, and duration of pain along with its socio-demographic distribution in a sample of 1,577 individuals aged 45+ years. We assess the association of pain with clinically validated measures of mental health, including depression and anxiety, and subjective well-being. Results Pain is widespread in this mature population with an average age of 60 years: 62% of respondents report the experience of at least minor pain during the last year, and half of these cases report severe or disabling pain. Women are more likely to report pain than men. Pain is a strong predictor of mental health and subjective well-being for both genders. More severe or longer pain episodes are associated with worse mental states. Individuals reporting pain are more likely to suffer from depression or express suicidal thoughts. Discussion and Implications Our study identifies key sub-populations such as older women in a SSA low-income context who are particularly affected by the experience of pain in daily life and calls for interventions targeting pain and its consequences for mental health and subjective well-being.

Prevalence and influencing factors of chronic pain in middle-aged and older adults in China: results of a nationally representative survey

“…Specifically, women are more likely to experience physical pain than men, which is consistent with previous studies ( 17 , 18 ), and women may be experiencing more pain ( 19 , 20 ). Thus, the findings provided evidence for targeted strategies by the health sector to address pain in middle-aged and older women.…”

Resilience, Accelerated Aging, and Persistently Poor Health: Diverse Trajectories of Health in Malawi

“…For example, in our study population, high blood pressure is common among older individuals despite the lack of conventional risk factors such as obesity or access to Western-type diets (Kohler et al 2020(Kohler et al , 2022b; NCD Risk Factor Collaboration (NCD-RisC) 2021). Declines in physical and mental health occur on average in this cohort at younger ages as compared to individuals in HICs (Kohler et al 2022a(Kohler et al , 2023, and similar patterns of early health declines have been documented in other populations exposed to significant lifecourse adversities (Geronimus et al 2006;Phelan and Link 2015;Simons et al 2021). Global aging research is also only starting to document the determinants and correlates of trajectories of later-life health and aging in LICs (NASEM 2019; National Academy of Medicine 2022), with LIC aging studies-such as the MLSFHallowing important new perspectives on aging research that so far has focused primarily on high-and middle-income countries (Figure 1).…”

“…Currently, remaining life expectancy at age 45 is ≈28 years (UN Population Division 2019) and healthy life expectancy is ≈22 years (GBD 2019 Disease Collaboration 2020). Older adults aged 45+ years can expect to live a large proportion of their remaining life expectancy subject to physical and mental health limitations impacting their daily activities and overall wellbeing (Kohler et al 2017(Kohler et al , 2022a(Kohler et al , 2022b(Kohler et al , 2023Payne, Mkandawire, and Kohler 2013). HIV/AIDS remains widespread, with a prevalence of about 7.4 percent among rural adults 15-49 years old (Malawi DHS 2017).…”

Labour's pain: strenuous subsistence work, mechanical wear-and-tear and musculoskeletal pain in a non-industrialized population

“…Consistent with this hypothesis, age-standardized current pain prevalence is 1.7–8.2 times higher for Tsimane than other populations (figure 3), and Tsimane back pain is more prevalent than pain at other anatomical locations. Back and other pain is also prevalent in adults from certain rural low-income African populations whose livelihoods rely on strenuous physical labour [23]. Work-related repetitive mechanical stress or trauma can accelerate senescence of musculoskeletal tissues including load-bearing joints, as suggested by the relatively high rates of often painful OA in the distal interphalangeal joints of textile mill workers [61], in the knees of those with physically demanding occupations entailing frequent knee bending [62], in the hips of farmers regularly lifting heavy weights for prolonged periods [63], and in joints that are rarely affected by OA (e.g.…”

“…One way to identify environmental, lifestyle, and biological factors contributing to pain aetiology is to focus on small-scale rural subsistence-level populations, which typically experience social, ecological and epidemiological conditions more similar to those found over most of human history. These conditions include physically active lifestyles [20,21], which have been inconsistently associated with pain vulnerability: meta-analyses of controlled trials suggest protective effects of regular exercise [22], but population-based studies indicate high pain prevalence among physically active adults routinely engaging in strenuous labour for sustenance [23]. Other conditions include, relative to the post-industrialized populations where most pain research occurs, fewer opportunities for prolonged rest following pain onset and limited occupational alternatives.…”