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Threats to social safety and pain: A global study
Mon, August 10, 10:00 to 11:00am, TBAAbstract
Pain is not distributed evenly across countries, with prevalence rates varying from as low as 10% in some nations to as high as 50% in others. Prior work links macro-level sociostructural factors to pain, yet findings are inconsistent. For example, less developed countries are just as likely to have high or low pain prevalence. We examined whether threats to social safety predict pain and tested whether micro-level interpersonal difficulties (ID) predict pain, whether macro-level structural stigma (SS) predicts pain, and whether SS amplifies the relationship between interpersonal difficulties (ID) and pain. Individual data from 253,659 adults in 67 countries participating in the World Health Survey (2002–2004) were linked with cross-national measures of SS from the Varieties of Democracy project. Ordinal logistic regression models, including pooled, country fixed effects, and mixed effects specifications, were estimated adjusting for age, gender, education, and subjective health. ID showed a strong association with more severe pain across all models (ORs = 1.32–1.79, all p < 0.001). SS did not predict pain as a main effect (OR = 1.11, p = 0.20) but significantly amplified the ID–pain association (interaction OR = 1.25, p = 0.003), yielding much higher predicted probabilities of severe and extreme pain for individuals reporting high ID in high-SS contexts. These findings suggest that macro-level exclusion may not shift average pain directly but instead strengthens the effect of interpersonal social safety threat on pain, offering a potential explanation for some inconsistencies in cross-national research on pain prevalence.