Trauma, social support, family conflict, and chronic pain in recent service veterans: does gender matter?
OBJECTIVE
Women veterans have a higher prevalence of chronic pain relative to men. One hypothesis is that differential combat and traumatic sexual experiences and attenuated levels of social support between men and women may differentially contribute to the development and perpetuation of pain. This investigation examined [1] gender differences in trauma, social support, and family conflict among veterans with chronic pain, and [2] whether trauma, social support, and family conflict were differentially associated with pain severity, pain interference, and depressive symptom severity as a function of gender.


METHODS
Participants included 460 veterans (56% female) who served in support of recent conflicts, and who endorsed pain lasting 3 months or longer. Participants completed a baseline survey during participation in a longitudinal investigation. Self-report measures included pain severity, pain interference, depressive symptom severity, exposure to traumatic life events, emotional and tangible support, and family conflict.


RESULTS
Relative to men, women veterans reporting chronic pain evidenced higher rates of childhood interpersonal trauma (51% vs 34%; P < 0.001) and military sexual trauma (54% vs 3%; P < 0.001), along with lower levels of combat exposure (10.00 vs 16.85, P < 0.001). Gender was found to be a moderator of the association of marital status, combat exposure, childhood interpersonal trauma, and family conflict with pain interference. It also moderated family conflict in the prediction of depressive symptoms.


CONCLUSIONS
Results underscore the potential importance of developing and testing gender specific models of chronic pain that consider the relative roles of trauma, social support, and family conflict.
Department of Psychology, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.|Department of Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
Mary A
MA
Driscoll
Anesthesiology, Critical Care, and Pain Medicine Service, VA Boston Healthcare System, 150 S. Huntington Avenue, Jamaica Plain, 02130, MA, USA.|Department of Psychiatry, Boston University School of Medicine, 72 E. Concord Street, Boston, MA, 02118, USA.
Diana M
DM
Higgins
Ferkauf Graduate School of Psychology, Yeshiva University, 500 W. 185th Street, New York, NY, 10033, USA.|Saul R. Korey Department of Neurology, Albert Einstein College of Medicine of Yeshiva University, 1300 Morris Park Avenue, Bronx, NY, 10461.
Elizabeth K
EK
Seng
VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.|Yale University, School of Public Health, 333 Cedar Street, New Haven, CT, 06510, USA.
Eugenia
E
Buta
Joseph L
JL
Goulet
Department of Psychology, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.|Department of Psychiatry, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
Alicia A
AA
Heapy
Department of Psychology, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.|Departments of Psychiatry, Psychology, and Neurology, Yale University, 333 Cedar Street, New Haven, CT, 06510, USA.
Robert D
RD
Kerns
VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.|Department of Emergency Medicine, Yale University School Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
Cynthia A
CA
Brandt
Department of General Internal Medicine, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT, 06516, USA.|Department of General Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
Sally G
SG
Haskell
D000328:Adult; D055826:Afghan Campaign 2001-; D059350:Chronic Pain / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D015331:Cohort Studies; D054541:Family Conflict / Q000523:psychology*; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
Chronic Pain; Gender; Support; Trauma; Veterans