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Race, Social Status, and Depressive Symptoms: A Moderated Mediation Analysis of Chronic Low Back Pain Interference

Edwin N Aroke1, Pamela Jackson2, Demario S Overstreet3

  • 1Nurse Anesthesia Track.

The Clinical Journal of Pain
|June 4, 2020
PubMed

Insights

Racial disparities in chronic low back pain (cLBP) persist. Higher social status benefits pain outcomes for white individuals, but not for Black individuals, highlighting a critical gap in cLBP management.

Area of Science:

  • Health Disparities
  • Pain Management
  • Sociology

Background:

  • Chronic low back pain (cLBP) is a leading cause of disability with substantial societal costs.
  • Disparities in cLBP prevalence and impact are evident, disproportionately affecting Black individuals and those of lower socioeconomic status.
  • Existing biopsychosocial frameworks for cLBP management have not fully addressed these persistent disparities.

Purpose of the Study:

  • To examine if self-identified race moderates the relationship between perceived social status and cLBP outcomes (pain interference and severity).
  • To investigate if race moderates the indirect effect of perceived social status on pain outcomes through depressive symptoms.

Main Methods:

  • Recruited 57 Black and 48 White participants with cLBP.
  • Measured depressive symptoms, socioeconomic status (objective and subjective), and pain outcomes.
  • Employed Hayes' moderated mediation model to analyze direct and indirect relationships.

Main Results:

  • Black participants reported significantly higher pain interference and severity than White participants (P<0.05).
  • Race moderated the association between perceived social status and pain interference; higher status reduced pain for Whites but not for Blacks.
  • Race significantly moderated the association between perceived social status and depressive symptoms (P<0.001), which mediate pain outcomes.

Conclusions:

  • Higher perceived social status is linked to lower depressive symptoms, subsequently reducing pain severity and interference in White individuals with cLBP.
  • This association between perceived social status, depressive symptoms, and pain outcomes was not observed in Black individuals with cLBP.
  • Findings underscore the need to address racial disparities in chronic low back pain management, particularly the differential impact of socioeconomic factors.
Abstract

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