Stress resilience or stress proliferation? The impact of life course cumulative stress on pain

• In Event: Aging and the Life Course Section Roundtables
  In Refereed Roundtable (90 minute): 2: Life course Approaches to Mental Health and Well-being

Abstract

Studies consistently show that higher stress predicts elevated pain risk and worse pain-related functioning. Yet, life-course research on pain remains relatively limited, and potential resilience outcome patterns (i.e., maintaining or improving health status after trauma) are obscured by the heavy reliance on linear modeling. At the same time, a growing body of work highlights resilience resources, such as social support and self-esteem, that can mitigate stress impact, but much of this research either treats these resources only as moderators or, when conducting mediation analysis, does not evaluate how stress and resilience resources dynamically interact within stress-health pathways. Using data from the Midlife in the United States (MIDUS) study, this study assesses how multidomain cumulative stress across childhood and adulthood relates to three distinct chronic pain outcomes: chronic pain status, pain interference, and the number of pain sites. The analysis explicitly models nonlinearity in stress-pain associations, and explores how social support and self-esteem influence pain through mediation, interaction with stress, and their combined effects, using the four-way decomposition method. Findings reveal that the association between stress and chronic pain is largely linear. In contrast, both pain interference and the number of pain sites follow a pronounced J-shaped pattern, with little difference at low-to-moderate stress levels and sharp increases at the highest stress levels. Both social support and self-esteem exhibit mediating effects, and results for self-esteem additionally reveal an exposure-mediator interaction for pain interference, suggesting that stress-attributable declines in self-esteem can amplify the functional consequences of cumulative stress.

Authors

• Rui (Zoe) Huang, SUNY-Buffalo

• Yuhang Li, University at Albany, SUNY