Abstract
Objective The aim of this study was to uncover possible psychosocial underpinnings of pain and sleep disturbance in a safety-net primary care sample. Methods Patients (n = 210) awaiting care in a safety-net primary care clinic waiting room completed measures of cynical hostility, social support, mental health, sleep disturbance, and pain. This study was cross-sectional and observational. Results A structural equation model suggested that higher cynical hostility was associated with lower social support, which in turn was associated with poorer mental health, which then corresponded with higher pain and sleep disturbance. All possible indirect (mediational) effects within this model were statistically significant, suggesting a possible route through which cynical hostility may shape pain and sleep, two common presenting problems in primary care. Conclusions These findings illustrate the interplay of psychosocial factors with chronic pain and sleep disturbance in a sample of low-income, predominantly African-American patients seeking care at a safety-net primary care clinic. The findings support integrated primary care as a way to target not only behavioral health issues but also the psychosocial factors entangled with physical health.
Highlights
Chronic pain and sleep disturbance are two of the most common presenting problems in primary care [1]
The field of health psychology outlines several psychosocial factors potentially contributing to these problems. e psychosocial vulnerability model argues that cynical hostility, an attitude characterized by distrust toward others, erodes people’s health by weakening social support [10, 11], and research has supported this connection [11, 12]
We hypothesized that cynical hostility would dampen social support, consistent with the psychosocial vulnerability model, which would in turn correspond with poor mental health, thereby increasing sleep disturbance and pain. e sample for this
Summary
Chronic pain and sleep disturbance are two of the most common presenting problems in primary care [1]. E psychosocial vulnerability model argues that cynical hostility, an attitude characterized by distrust toward others, erodes people’s health by weakening social support [10, 11], and research has supported this connection [11, 12]. Recent research, for example, work connecting alexithymia—the inability to identify and articulate emotions—to a range of chronic pain conditions shows the importance of psychological factors in problems that are commonly present in medical settings [21]. E present study aimed to elucidate the psychosocial factors underlying pain and sleep disturbance in a primary care sample. We hypothesized that cynical hostility would dampen social support, consistent with the psychosocial vulnerability model, which would in turn correspond with poor mental health (i.e., depression and anxiety), thereby increasing sleep disturbance and pain. Lower socioeconomic status is a predictor for both chronic pain [22] and sleep disturbance [23], as well as poor health and mortality more broadly [24], making the study of this population important in light of health disparities in the United States [25]
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