Publication year
2015
Citation Title
Trauma, social support, family conflict, and chronic pain in recent service veterans: Does gender matter?
Journal Name
Pain Medicine
Journal Volume
16
Issue Number
6
Page Numbers
1101-1111
DOI
10.1111/pme.12744
Summary
Social support variables and traumatic experiences were examined as predictors of pain outcomes in a group of EF/OIF/OND Veterans experiencing chronic pain, with particular attention to whether these relationships differed between men and women. Marital status, combat exposure, and family conflict were found to predict pain outcomes differently in women and men.
Key Findings
The relationships between some social and trauma variables and pain outcomes differed between men and women.
Being married predicted higher pain interference in women as did combat exposure.
For men, being married predicted lower pain interference and there was no relationship between combat exposure and pain interference.
Increased family conflict predicted higher pain interference and depressive symptoms in men, but did not predict those same outcomes for women.
Implications for Program Leaders
Publicize information regarding the factors that predict decreased pain outcomes among Service members and their family members who experience chronic pain
Offer professional development training for community providers on how to support military family members coping with chronic pain
Facilitate support groups for married female Service members coping with chronic pain
Implications for Policy Makers
Encourage collaboration between Veteran Affairs (VA) health care systems and community-based mental health providers to form partnerships to assist Veterans experiencing chronic pain through addressing social supports and traumatic experiences
Suggest professional development for community providers about how to support Service members experiencing chronic pain
Support screening for social support and traumatic experiences for Service members with chronic pain
Methods
Data were from a larger, longitudinal study exploring health care utilization, health outcomes, and cost of care for a cohort of male and female EF/OIF/OND Veterans.
Mailings were sent to 8,465 Veterans; 767 consented to participate, 662 completed the surveys, and 460 reported having pain for at least three months.
Participants completed surveys measuring pain outcomes, depressive symptoms, combat exposure, traumatic life events, military sexual trauma, social support, and family conflict.
Participants
Participants were 460 Veterans (56% female) enrolled in VA health care in New England and Indiana/Illinois between September 2001 and September 2012.
The average age was 35.54 years (SD = 10.58 years) for male participants and 32.38 years (SD = 10.65 years) for female participants; race/ethnicity data were not provided.
Overall, 75% of participants indicated their pain had been present for at least a year, with back pain (37%) and joint pain (33%) the most common reported pain.
Limitations
The participants in this sample reported mild pain outcomes; therefore, results may not be generalizable to populations with more significant pain outcomes.
Data were gathered using a cross-sectional method, which does not allow for analysis of causation.
Participants opted into the study by responding to mailings, which could bias results since Veterans who participated in the study may differ in important ways from those who did not opt into the study.
Avenues for Future Research
Consider extending these findings to a population with more severe pain, for example, a study of Service members who are actively seeking treatment for their pain
Explore the relationship between military sexual trauma and pain outcomes between men and women
Compare interventions for Service members experiencing chronic pain that are tailored to men or women versus treatment as usual
Focus
Multiple Branches
Population Focus
Military Branch
Military Component
Abstract
Objective: Women veterans have a higher prevalence of chronic pain relative to men. One hypothesis is that differential combat and traumatic sexual experiences and attenuated levels of social support between men and women may differentially contribute to the development and perpetuation of pain. This investigation examined gender differences in trauma, social support, and family conflict among veterans with chronic pain, and whether trauma, social support, and family conflict were differentially associated with pain severity, pain interference, and depressive symptom severity as a function of gender. Methods: Participants included 460 veterans (56% female) who served in support of recent conflicts, and who endorsed pain lasting 3 months or longer. Participants completed a baseline survey during participation in a longitudinal investigation. Self-report measures included pain severity, pain interference, depressive symptom severity, exposure to traumatic life events, emotional and tangible support, and family conflict. Results: Relative to men, women veterans reporting chronic pain evidenced higher rates of childhood interpersonal trauma (51% vs 34%; P < 0.001) and military sexual trauma (54% vs 3%; P < 0.001), along with lower levels of combat exposure (10.00 vs 16.85, P < 0.001). Gender was found to be a moderator of the association of marital status, combat exposure, childhood interpersonal trauma, and family conflict with pain interference. It also moderated family conflict in the prediction of depressive symptoms. Conclusions: Results underscore the potential importance of developing and testing gender specific models of chronic pain that consider the relative roles of trauma, social support, and family conflict.
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