The Intersection of Pain, Mental Health, and Functional Ability for Older African American Men

Background: Pain interference, or the degree to which pain interfered with one’s normal activities during the previous four weeks is a significant indicator of quality of life.

Research is limited regarding African Americans’ experience of chronic interfering pain, however, studies have established that overall, African American patients receive disparate pain-related health communication and care, though these disparities have rarely been investigated with specific regard to age and gender. The current study sought to address this gap by investigating the factors associated with chronic interfering pain among older African American men. A growing body of literature confirms that depression and anxiety affect an individual’s perceptions of pain. Thus, we also sought to examine the role of mental health in the experience of chronic interfering pain for older African American men. Mental health is of particular concern because African American men report greater rates of depression symptomology but lower rates of diagnosed clinical depression than their white male counterparts.  

Methods: A secondary analysis was completed using data from 1,666 older African American men recruited between 2006 and 2010 for a larger cancer prevention study in Southeast Michigan conducted by a large health system.  The men on average were 73.6 years old. Approximately 45% were married and 38% had at least some college education. Nearly 6% of older African American men in this study (N= 213) reported experiencing chronic pain that interfered with their normal activities. More than 80% of the men (1,357) reported experiencing moderate or serious anxiety or depression.

Results: Logistic regression revealed that difficulty with mobility (OR=2.05), problems with self-care (OR=2.19), and self-reported depression and anxiety (OR=2.94) were all significant predictors of interfering pain in the older African American men (X²=109.92, p=.000).

Implications: These findings highlight the understudied subgroups of African American men who may be particularly vulnerable to chronic interfering pain, namely older men with mobility, self-care, and mental health challenges. While it is unknown whether these conditions preceded the experience of interfering pain or developed as a result of pain, physicians and other health care professionals should be attuned to the complex intersection of pain, mental health, and functional ability, particularly as experienced by medically underserved populations such as older African American men. Social workers are poised to support health care teams in more carefully assessing pain needs in light of other risk factors. Recent research documenting implicit biases held by medical students and health care providers with regard to African Americans’ experience of pain and need for pain management, highlights the need for additional research and advocacy on behalf of this population.