Stressful Family Environment and Chronic Pain in Middle Childhood: An Examination of the Moderating Effects of Social Status and Positive Family Resources

Chronic pain is common among children and can lead to future physical disability and health problems. The Biopsychosocial model of child pain suggests that biological, psychological, and social factors predict pain risk, but most research has focused on biological and psychological factors impacting child pain, and less on social factors. One social factor is family stress, including parent mental and physical health problems, and parenting and marital stress. The impact of stress, however, may vary depending on the presence of positive family resources, including marital empathy, parental warmth, and interpersonal support. Thus, the current longitudinal study examined links between family stress and increases in child pain during middle childhood and tested whether positive resources acted as a buffer to protect the development of child pain and if low social status acted as an extra stressor to make pain worse. Participants were part of the Arizona Twin Project, an ongoing longitudinal project of twins. At twin age 9, primary caregivers (PCs) reported on different stress, social status, and positive resources measures, and PCs and twins reported on twin bodily pain. At twin age 11, PCs and twins again reported on twin chronic bodily pain. Neither greater family stress nor parent physical health problems predicted increases in child pain over two years, controlling for twin pain at age 9. In tests of moderation, a single significant interaction emerged in a direction opposite of prediction: the relation between family stress and child pain was moderated by social status, such that average and high levels of social status exacerbated the relation between family stress, and child pain at age 11. Although the interaction needs to be replicated, findings suggest that high social status may act as a risk factor for poor child physical health and pain when family stress is high. Future research should further explore whether and how family stress and social status, as well as peer stress and resources, alone and in combination predict health as children age into adolescence.