Bidirectional Associations Between Pain and Perceived Stress Among Veterans: Depressive Disorder as a Predisposing
Shaddy K Saba1, Jordan P Davis, John J Prindle
1From the Suzanne Dworak-Peck School of Social Work (Saba, Davis, Prindle, Bunyi, Castro), University of Southern California, Los Angeles; Department of Psychology (Howe), University of California, Berkeley, Berkeley; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine (Tran, Pedersen), University of Southern California, Los Angeles; and RAND Corporation (Hummer), Santa Monica, California.
Psychosomatic Medicine
|September 29, 2023
Summary
Combat-injured veterans with depression experience a bidirectional link between pain and stress. Addressing depression is key for managing pain and stress in this population.
Area of Science:
- Psychology
- Neuroscience
- Military Medicine
Background:
- Combat-injured veterans frequently report pain, stress, and depression.
- The systems model of pain posits bidirectional associations between pain and stress, amplified by depression.
- This model lacks empirical validation in veteran populations.
Purpose of the Study:
- To empirically test the systems model of pain in combat-injured veterans.
- To examine the within-person associations between pain and perceived stress.
- To determine if these associations differ based on depressive disorder status.
Main Methods:
- A longitudinal study of 902 combat-injured veterans over 18 months.
- Utilized a multigroup, autoregressive latent trajectory with structured residual model.
- Assessed within-person associations between pain and perceived stress, stratified by depression screening.
Main Results:
- The systems model of pain was supported among veterans with depressive disorder.
- Perceived stress positively predicted subsequent pain (b=0.12).
- Pain positively predicted subsequent perceived stress (b=0.44) in this subgroup.
Conclusions:
- Pain and perceived stress are bidirectionally linked in combat-injured veterans with depression.
- Depressive disorder significantly influences the pain-stress relationship.
- Clinicians must screen for and address depression in veterans with pain and stress.
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