This dissertation investigated the relationship between pain intensity and depressive symptoms for older married adults, and examined whether positive and negative spousal interactions buffered and/or exacerbated the impact of pain intensity on depressive symptoms. The stress process theory (Pearlin, 1989) and social interaction theories (Cohen & Wills, 1985; Rook, 1984) provide the theoretical grounds for hypotheses in this dissertation. The sample consisted of 863 married adults with pain, age 60 and older, obtained from the Health and Retirement Study 2014 data. Hierarchical negative binomial regression models were applied.
Results partially supported the relationship between pain intensity (i.e., mild, moderate, or severe pain) and depressive symptoms. The severe pain intensity group showed significantly higher depressive symptoms than the moderate pain group. There was no significant difference in depressive symptoms between the mild and moderate pain groups. Results also partially supported the exacerbating effects of negative spousal interactions (NSI). NSI increased the effect of pain intensity only when respondents reported mild or moderate pain. NSI did not exacerbate the relationship between severe pain intensity and depressive symptoms. This dissertation found inconsistent results about the buffering effect of positive spousal interactions (PSI). PSI buffered the relationship between pain intensity and number of depressive symptoms across all levels of pain intensity when moderating effects of NSI were not controlled. However, PSI was not a significant moderator when the moderating effects of NSI were controlled.
Social workers need to educate other healthcare professionals about the necessity of adequate pain treatment, emphasizing that older adults with severe pain are at risk of having higher depressive symptoms. Pain management interventions need to be tailored for older adults with co-occurring severe pain and depressive symptoms. Interventions also need to integrate psychoeducational contents about negative spousal interactions with content about pain management for older adults with mild or moderate pain. The inconsistent results about the buffering effects of PSI suggest caution in a hasty conclusion that only NSI, not PSI, is a significant moderator. Future studies are needed to clarify the relationship between PSI and NSI and gain further insight into differences between pain intensity groups.