Depression, Cognition, and Pain: Exploring Individual, Cultural and Country-Level Effects Across Europe

The aim of this paper was to investigate the role of economic (eg, GDP per capita), political (eg, healthcare spending), cultural (country-level aggregates norms) and individual correlates (eg, depression) of pain in a secondary analysis of a sample of 76,000 adults in 19 countries across Europe. The sample was aggregated from 2 waves of the Study of Health, Ageing and Retirement in Europe cohort, using multilevel models with cross-level interactions between individual and country-level effects. While there has been extensive focus on individual risk factors (eg, depression, cognition, BMI), the role of social, political and cultural contextual factors has been relatively underexplored. In addition to replicating well-established individual risk factors (eg, increased depression), we demonstrate that higher levels of depression, chronic pain diagnosis, and collectivism, aggregated at the country-level, are also associated with increased pain severity. There was evidence that these country-level effects moderate the effect of individual correlates of pain. These results contribute to the literature by identifying the importance of broader cultural factors alongside individual psychological indices of pain reporting. PERSPECTIVE: In this study we model how individual, political and cultural factors influence pain in a large cross-national sample. In addition to replicating established individual effects, it shows how cultural (ie, collectivism) and political (eg, GDP, healthcare spending) factors affect individual expressions of pain, and how the cultural and individual factors interact with each other.