Psychological pathways from daily discrimination to pain: a longitudinal mediation model

Perceived discrimination, self-esteem, and self-acceptance have each been linked to pain outcomes, yet few studies have examined these factors together or investigated the psychological pathways connecting them. Grounded in the Biopsychosocial framework, this study explored the longitudinal mediating roles of self-esteem and self-acceptance in the relationship between perceived daily discrimination and pain interference. Archival data were drawn from the Midlife in the United States (MIDUS) study, with MIDUS II (2004-2006) as Time 1 and MIDUS III (2013-2014) as Time 2. The sample included 501 participants (ages 34-83) who self-reported chronic pain at both timepoints; the majority identified as White (92.2%) and female (60.7%). A multiple longitudinal mediation analysis revealed that perceived daily discrimination at Time 1 predicted greater pain interference at Time 2, an association mediated by lower levels of self-acceptance and self-esteem at Time 2. Notably, self-acceptance emerged as a more robust mediator than self-esteem. These findings suggest that the long-term impact of discrimination on pain outcomes may operate through its erosion of the sense of self, particularly self-acceptance. Clinically, these findings highlight the importance of addressing discrimination's influence on self-acceptance as a critical pathway for intervention, prevention, and future research.