Symptoms of Depression and Insomnia Help Explain the Relationship Between Stigma and Chronic Pain Severity in People with HIV

Abstract

People living with HIV experience high rates of chronic pain. HIV and chronic pain are both highly stigmatized health conditions. Previous research suggests that stigmatization has negative consequences on mood, sleep, and pain outcomes. Whether the relationship between stigma and chronic pain severity can be explained by symptoms of depression and insomnia has yet to be determined. Participants included 85 people with HIV and chronic pain recruited from an HIV Clinic at a major medical campus. Participants completed the HIV Stigma Mechanisms Scale and the Internalized Stigma of Chronic Pain Scale, as well as the Center for Epidemiological Studies Depression Scale, the Insomnia Severity Index, and the Brief Pain Inventory-Short Form. A series of sequential mediation models controlling for covariates were analyzed via bootstrapping methods. The indirect effect of HIV stigma on chronic pain severity through both depressive symptoms and insomnia severity was significant with a point estimate of .026 and a 95% confidence interval of .003 to .057. In a subsequent model, the same pattern of significant results was found when examining the indirect effect of chronic pain stigma on chronic pain severity through depressive symptoms and insomnia severity (point estimate of .728 and a 95% confidence interval of .259 to 1.360). Findings suggest that the experience of both HIV and chronic pain stigma may perpetuate depressed mood, which can lead to poor sleep (i.e., insomnia). In turn, depression and insomnia can exacerbate the chronic pain severity of people with HIV. These findings are important because stigma-related worsening of mood, sleep, and chronic pain is likely to impede appropriate HIV management and retention in care. UAB center for AIDS research: P30AI027767, NHLBI: R01HL147603.