Research focussing on individual biopsychosocial processes leading to physical pain as a health condition is rare. The present study investigated sense of control as a mechanism linking early midlife stress to later-life physical pain for husbands and wives in long-term marriages. Using data from 508 rural husbands and wives over 27 years with respondents in their early middle years (<42 years on average) in 1991 and in their later years (>67 years on average) in 2017, this study utilized a comprehensive analytical model in an structural equation modelling framework. Family financial stress (FFS) trajectories in early middle years were associated with depleted sense of control, which was related to increased physical pain in later years after controlling for concurrent physical illness, family income and age. In cross-lagged analyses FFS influenced physical pain over mid-later years.Physical pain also influenced FFS, suggesting a bi-directional association between FFS and physical pain. Findings elucidate how early midlife FFS influences the progression of physical pain over mid-later years through sense of control. Findings suggest effective intervention and prevention programs should focus on FFS in early years of adulthood as well as the maintenance and development of adults' sense of control.
K E Y W O R D Sfamily financial stress, long-term marriages, physical pain, sense of control
| INTRODUCTIONPhysical pain is a common symptom of chronic and acute health problems that past research has shown is a biopsychosocial phenomenon with a dual nature (Croft et al., 2010;Williams & Craig, 2016). That is, independent of being a symptom of health problems and underlying biological conditions, persistent physical pain, as a neurological health condition, partly reflects experiences with stressful psychosocial conditions (Brown et al., 2018;Fine, 2011). Thus, persistent or chronic physical pain has been increasingly recognized as a poor health condition in its own right that is prevalent among a substantial portion of adult population, particularly older adults (Croft et al., 2010). In fact, the prevalence of physical pain in the United States (US) population has dramatically increased in recent decades, and it has become a major public health concern (Chou et al., 2016).The prevalence of physical pain has a large economic cost (Chou et al., 2016;Gaskin & Richard, 2012) and has resulted in a substantial increase in painkiller dependence in the US (Substance Abuse and Mental Health Services Administration, 2014). Furthermore, at the individual and family levels, persistent physical pain adversely influences activities of daily life (e.g., housework, physical activity), and persistent physical pain is often comorbid with, and impacts, multiple health conditions, such as physical limitations, depression, loneliness and cardiovascular health (Croft et al., 2010;Fine, 2011). However, less is known about the socioeconomic factors and associated individual psychosocial processes leading to physical pain as a health conditi...