Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women's Health Across the Nation.
Chronic discrimination and bodily pain in a multiethnic cohort of midlife women in the Study of Women's Health Across the Nation.
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DOI：
10.1097/j.pain.0000000000000957
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发表时间：
2017-09
期刊：
影响因子：
7.4
通讯作者：
Janssen I
中科院分区：
文献类型：
--
作者：
Dugan SA;Lewis TT;Everson-Rose SA;Jacobs EA;Harlow SD;Janssen I
越来越多的文献将歧视与生物行为健康的关键标志联系起来。虽然在实验和临床研究中可以看到种族/民族在疼痛方面的差异，但作者对长期的慢性歧视如何在多个种族/民族群体中导致疼痛感兴趣。参与者是来自全国妇女健康研究（SWAN）的3056名非裔美国人、高加索人、中国人、西班牙裔和日本妇女。日常歧视量表从基线到13次随访检查进行评估。SF-36的身体疼痛分量表每年评估一次。在关于歧视和疼痛的报告中，有很大的种族/民族差异。歧视归因也因种族/民族而异。在线性混合模型分析中，对年龄、教育程度和止痛药进行了初步调整，慢性日常歧视与所有种族的身体疼痛相关（日本人β = - 5.84, p< 0.002；非裔美国人β = - 6.17, p< 0.001；中国人β = - 8.74, p< 0.001；高加索人β = - 10.54, p< 0.001；西班牙人β = - 12.82, p< 0.001）。在随后的模型中调整了额外的协变量，直到添加抑郁症状作为协变量后，所有种族群体的关联仍然显著；在最终的完全调整模型中，歧视仍然是非洲裔美国人（beta= - 4.50, p<.001）、中国人（beta= - 6.62, p<.001）的疼痛显著预测因子；高加索女性（β = - 7.86 p<.001）。在这项纵向研究中，对绝大多数女性来说，日常歧视的经历与身体疼痛的报告密切相关。需要进一步研究，以确定是否解决心理社会压力因素，如歧视，与患者可以加强疼痛症状的临床管理。
A growing literature links discrimination to key markers of biobehavioral health. While racial/ethnic differences in pain are seen in experimental and clinical studies, the authors were interested in how chronic discrimination contributes to pain within multiple racial/ethnic groups over time. Participants were 3,056 African American, Caucasian, Chinese, Hispanic and Japanese women from the Study of Women’s Health Across the Nation (SWAN). The Everyday Discrimination Scale was assessed from baseline through thirteen follow-up exams. The bodily pain subscale of the SF-36 was assessed annually. There were large racial/ethnic differences in reports of discrimination and pain. Discrimination attributions also varied by race/ethnicity. In linear mixed model analyses, initially adjusted for age, education, and pain medications, chronic everyday discrimination was associated with more bodily pain in all ethnic groups (beta= −5.84, p<.002 for Japanese; beta = −6.17, p<.001 for African American; beta = −8.74, p<.001 for Chinese; beta= −10.54 for Caucasians, p<.001; beta = −12.82, p<.001 for Hispanic). Associations remained significant in all ethnic groups after adjusting for additional covariates in subsequent models until adding depressive symptoms as covariate; in the final fully-adjusted models, discrimination remained a significant predictor of pain for African American (beta = −4.50, p<.001), Chinese (beta= −6.62, p<.001); and Caucasian (beta = −7.86 p<.001) women. In this longitudinal study, experiences of everyday discrimination were strongly linked to reports of bodily pain for the vast majority of women. Further research is needed to determine if addressing psychosocial stressors, such as discrimination, with patients can enhance clinical management of pain symptoms.
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影响因子：
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作者：
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