This article was originally published here
Arthritis Care Res (Hoboken). 2020 Oct 7. doi: 10.1002/acr.24481. Online ahead of print.
ABSTRACT
OBJECTIVE: Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), we sought to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain.
METHODS: We analyzed baseline data from 270 African American and 247 White veterans enrolled in a randomized controlled trial testing a psychological intervention for chronic pain at two VA medical centers. Participants were aged ≥50 years and self-reported symptomatic knee OA. Measures included the Everyday Discrimination Scale, Patient Health Questionnaire Depression Scale (PHQ-8), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale, and demographic variables. Cumulative disadvantage was defined as the number of socially disadvantaged groups to which each participant belonged (i.e., self-reported female gender, African American race, income<$20,000, and/or unemployed due to disability). We used linear regression models and Sobel’s test of mediation to examine hypotheses.
RESULTS: The average number of social disadvantages was 1.3 (SD=1.0). Cumulative disadvantage was significantly associated with higher perceived discrimination, pain, and depression (p’s<.001). Perceived discrimination significantly mediated the association between cumulative disadvantage and depression symptoms (Z=3.75, p<.001) as well as pain severity (Z=2.24, p=.025).
CONCLUSION: Perceived discrimination is an important psychosocial stressor that contributes to poor OA-related mental and physical health outcomes, with greater effects among those from multiple socially disadvantaged groups.
PMID:33026710 | DOI:10.1002/acr.24481
