CHRONIC PAIN AND SOCIAL RELATIONSHIPS AMONG MIDLIFE AND OLDER ADULTS IN THE UNITED STATES

The prevalence of chronic pain in the over-50 population is approximately 25-35% and
has been rising over time in the United States. However, the social consequences of chronic pain
in later life are relatively understudied in the social sciences. This dissertation examines whether
and how chronic pain impacts social lives among midlife and older adults in the United States.
Drawing on data from the Health and Retirement Study (HRS), I address this research question
with three empirical chapters using a variety of statistical models.
In the first empirical chapter, I examine the impact of chronic pain on relationship-typespecific support and strain from spouses, children, relatives, and friends. Two competing
perspectives — the classic sick role theory versus pain as a threat to social self — were tested. I
first use group-based trajectory models to identify four pain trajectory groups, then analyze the
associations between relationship-type-specific support and strain and pain trajectory groups
with multilevel mixed-effect models. Results suggest that respondents who were consistently
experiencing moderate or severe pain perceived less support and more strain from all types of
relationships. Therefore, the classic sick role hypothesis is not supported, but the pain as a “threat
to the social self” hypothesis is supported by my findings.
The second empirical chapter investigates the association between chronic pain and
marital quality among older heterosexual couples using dyadic analysis of Actor–Partner
Interdependence Models. Results indicate that an actors’ moderate pain is marginally associated
with perceiving more support from their partners, while partners’ moderate and severe pain is
significantly associated with actor’s perceptions of less spousal support. Also, an individual’s
moderate pain and his/her partner’s moderate and severe pain are associated with more strain
from the partner. The relationship between partners’ pain and spousal support varies by gender in
that wives whose husbands experience pain perceive less spousal support, but not vice versa.
In the final empirical chapter, I examine how onset of chronic pain is associated with two
aspects of friendship in later life, using linear regression with a lagged dependent variable
approach. Results show that the onset of moderate pain is marginally associated with reporting
more friends and more frequent meet-ups, which is similar to the effects of life-threatening
disease (e.g., cancer) on friendship. This association can be interpreted by both classic sick role
theory and the social network activation perspective. However, different from life-threatening
diseases, more severe condition, i.e., onset of severe pain, does not necessarily predict more
friends or more frequent meetings, indicating that both timing and severity of pain matter in
predicting friendship in later life.
Overall, my dissertation integrates sociological theories in aging, health, and social
relationships/networks, and uses advanced statistical methods to explore the social consequences
of chronic pain.