Protective and Risk Factors at the Intersection of Chronic Pain, Depression, Anxiety, and Somatic Amplification: A Latent Profile Approach

Objective: Research indicates a complex nexus between chronic pain, depression, anxiety, and somatic amplification (PDAS) symptoms, marked by high rates of co-morbidity and mutually maintaining mechanisms. Although recent frameworks have attempted to explain co-occurrence rates of pain and other comorbid disorders, the interrelations between PDAS and their impacts on pain outcomes have not been adequately examined with a person centered approach. Using nationally representative data, this study assessed the heterogeneity in PDAS symptomatology and examined links among risk and protective factors in different profiles. Methods: Data were derived from 1027 participants in the National Survey of Midlife Development in the United States (MIDUS) who completed telephone interviews or self report measures that assessed PDAS, various sources of social supports (family, friends, spouses/partners, religion, coworkers, and supervisors), and the number of healthcare visits. Results: We found heterogeneity in symptom severity rather than symptom type across classes over time. Regardless of comorbidity severity, people reported similar levels of somatic symptoms, which may help clinicians more effectively diagnose comorbidity issues among chronic pain patients. As PDAS symptomatology increased by group, the perceived levels of social support decreased. Membership in a higher symptom severity class was associated with being female, younger age, and an increase in medical, but not mental health visits. Limitations: Limitations included the use of a cross-sectional design, reliance on self-report measures, and a sample largely comprised of Whites. Conclusion: PDAS co-occurs across classes, which may relate to shared risk and protective factors. This study lays the foundation to investigate similar questions for overlapping symptoms that occur during the same period, which would shed light on whether-among middle to older age adults-these disorders are attributable to a common mechanism and if they may inform transdiagnostic treatments.