title: Predictors of distress and depression in elders with arthritic pain.
abstract: OBJECTIVE
  The aim of this paper is to report the findings of a study testing a theory of chronic pain, with financial hardship added as a contextual stimulus.
  
  
  BACKGROUND
  Arthritis is highly prevalent among older people, resulting in severe pain and suffering. A previous study testing a theory of chronic pain in elders with arthritis found that pain, disability and social support explained only 35% of the variance in their emotional distress. It is possible that demands, other than chronic pain, such as financial hardship, also contribute to these elders' stress and depression.
  
  
  METHODS
  The theory was tested with 235 elders with arthritis using a secondary data analysis strategy. Data were obtained from the study of Ageing, Status, and Sense of Control carried out in 1998 in the United States of America. Variables were constructed from original questionnaires.
  
  
  RESULTS
  The hypothesized model fitted the data only moderately well (chi2 = 40.04, d.f = 6, P < 0.0001; CFI = 0.88; NFI = 0.88). Disability and financial hardship positively predicted distress, while social support and age had a reverse impact on distress, which explained 24% of the variance in distress. This means that elders with higher levels of disability, more financial hardship, less social support or younger age are likely to have higher levels of distress. Distress alone explained 33% of the variance in depressive symptoms. A data-derived model was created with excellent fit (chi2 = 3; d.f. = 4; P = 0.56; CFI = 1.00; NFI = 0.99), showing that disability, social support, financial hardship and age predicted distress (R2 = 0.24). Pain, disability and distress predicted depression (R2 = 0.44).
  
  
  CONCLUSIONS
  The results partially supported the theory. Exploring the possibility of using depression as part of the control process and removing gender as a residual stimulus may lead to further refinement of the theory. The findings allow nurses to have a better understanding of the experiences of elders with arthritis, and thus to offer appropriate care to meet their needs.
authors.affiliation: Department of Nursing Sciences, College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA. tsaipaofeng@uams.edu
authors.forename: Pao-Feng
authors.initials: PF
authors.lastname: Tsai
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D018771:Arthralgia / Q000523:psychology*; D001168:Arthritis / Q000523:psychology*; D002908:Chronic Disease; D003863:Depression / Q000209:etiology* / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D011203:Poverty; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology* / Q000523:psychology