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Beyond pain intensity: coping, social disconnection, and depression among Black older adults

Year: 2026

Type: article

Abstract: Background Pain is a physiological, psychological, and social stressor that contributes to functional disability and depression. Among Black older adults who often face multiple stressors, pain management may be deprioritized, increasing the risk of pain interference and exacerbation of depressive symptoms. The Roy Adaptation Model provides a multidimensional framework for understanding these relationships and identifying targets for culturally responsive interventions. This study examined the relationships between pain interference, adaptive coping, and social disconnection with depressive symptoms among a cohort of Black older adults with chronic pain. Methods The primary analysis included baseline survey data from 299 Black participants with complete data who were enrolled in a chronic pain self-management program. Measures included the PROMIS Emotional Distress-Depression 4a scale, the PROMIS Pain Interference 6a scale, the Coping and Adaptation Processing Scale (CAPS), and the UCLA Loneliness Scale. Multiple linear regression examined the relationships of pain interference, adaptive coping, and social disconnection with depressive symptoms, adjusting for age and gender. Analysis examined differences by living arrangement and added living alone versus with others to the regression models. Results The primary model was significant, F(5, 293) = 36.74, p < 0.001, explaining 39.2% of the variance in depressive symptoms. Social disconnection was the strongest predictor ( b = 1.90, β = 0.389, p < 0.001), followed by adaptive coping ( b = −0.27, β = −.190, p = 0.001) and pain interference ( b = 0.20, β = 0.180, p = 0.002). Participants living alone reported greater social disconnection than those living with others, although unadjusted depressive symptoms did not differ. In the expanded model, living alone was associated with lower depressive symptoms after adjustment for social disconnection and other covariates (b = −1.77, β = −.104, p = 0.024). Discussion Findings, though specific to this cohort, support a multidimensional interpretation of chronic pain encompassing the physiologic, interdependence, and self-concept modes of the Roy Adaptation Model. Wholistic pain assessment may benefit from extending beyond pain intensity to include functional interference, coping capacity, depressive symptoms, and social relationship quality. Culturally responsive interventions may strengthen adaptive coping strategies and improve meaningful social connections while addressing pain-related functional limitations.

Source: Frontiers in Pain Research

DOI: 10.3389/fpain.2026.1959380

Authors: Sheria G. Robinson-Lane, Patricia Tillman-Meakins, Mary R. Janevic

Institution: University of Michigan

Language: English

Topic: Musculoskeletal pain and rehabilitation

Subfield: Physical Therapy, Sports Therapy and Rehabilitation

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,077