A long-term study of older adults found that symptoms of depression and loneliness may increase in the years before the onset of physical pain and could remain elevated afterward, pointing to a strong connection between mental health and pain development in later life.

Investigators analyzed data from 7,336 adults aged 50 years and older, using information collected from 2002 to 2023. Half of the participants reported moderate or severe pain during the study and were matched with controls who didn't report pain, adjusting for age, sex, and education level.

Depressive symptoms were already more common among individuals who later developed pain. Eight years before pain onset, their depressive symptom scores were 0.14 points higher compared with those without pain. At the time pain began, the difference had grown to 0.58 points and remained stable over the following 8 years.

Similarly, loneliness scores were 0.19 points higher in the pain group 8 years before pain onset and increased to 0.33 points higher 8 years after pain onset. The likelihood of reporting high loneliness was also greater in the pain group throughout the study.

In contrast, levels of social isolation—defined as objective lack of contact with others—were similar between the groups. This distinction suggested that subjective loneliness may be more closely linked to pain compared with objective social isolation.

The participants with lower education or wealth experienced a greater increase in depressive symptoms compared with those with higher socioeconomic status. At pain onset, depressive scores were 0.32 points higher in individuals with lower education and 0.47 points higher in those in the lowest wealth tertile.

The investigators relied on self-reported pain data and couldn't determine whether all cases met the clinical definition of chronic pain. However, the results remained consistent in sensitivity analyses that included only participants with repeated reports of pain. Data on treatments or interventions weren't available.

At baseline, the participants who later reported pain were also more likely to have medical conditions, including arthritis, hypertension, diabetes, and psychiatric disorders. However, even after adjusting for these factors, the associations between pain, depression, and loneliness persisted.

The investigators suggested that early identification and management of mental health symptoms in older adults may help reduce or delay the onset of pain. The findings highlighted a potential need for psychosocial screening in primary care, particularly among individuals with fewer socioeconomic resources.

The authors reported no competing interests.

Source: eClinicalMedicine