Bodily pain severity and emotional pain experience in old age : Analyses of potential mediators from representative Ghana aging survey

Objectives
Data on the association between pain and emotional health outcomes in old age primarily come from high-income samples. This study examines the cross-sectional association of bodily pain with emotional pain in a representative sample from Ghana, a lower-middle-income sub-Saharan African country. It investigates the potential mediators in the association.

Methods
Participants (N = 1201) from the Aging, Health, Psychological Well-being, and Health-seeking Behavior Study reported their experiences of bodily pain and emotional pain. Pain severity was assessed over the last 30 days using a cross-culturally validated item from the Medical Outcomes Study Short Form-36, while emotional pain was assessed with seven emotional distress items on a 4-level scale over the last 30 days. Multivariable logistic regressions and bootstrapping models assessed the hypothesized association.

Results
Mean (SD) age was 66.1 (11.9) years, and 63.3 % were women. Compared to no pain, mild (odds ratio (OR) = 2.05, 95 %CI = 1.31–3.22), moderate (OR = 2.83, 95 %CI = 1.80–4.45), and severe bodily pains (OR = 3.55, 95 %CI = 1.93–6.55) had higher odds for emotional pain. The associations were stronger among women (than men) and the≥65 age group (than the 50–64 age group). Functional limitations (47.1 %), physical activity (26.4 %), and sleep problems (22.2 %) significantly mediated the association.

Conclusions
The positive cross-sectional association between bodily pain and emotional pain generalizes to a sub-Saharan African country. Psychosomatic factors largely accounted for this association. Efforts to improve emotional health may consider pain and the mediators. More studies are needed in low- and middle-income countries to gauge generalizability fully.