RESUMO
OBJECTIVES: Older adults are the least likely age group to seek mental health services, and internalized stigma is an important reason why. We sought to further our understanding of which older adults are particularly likely to be affected by internalized stigma, and why, by investigating mental health literacy (MHL) as a moderator within the internalized stigma model of help-seeking. METHODS: We utilized a conditional process analysis of cross-sectional, secondary data from 350 distressed older adults. Participants completed an online survey consisting of measures of distress, perceived control, experiential avoidance, MHL, public and self-stigma of seeking help, help-seeking attitudes, and conditional help-seeking intentions. RESULTS: MHL moderated the internalized stigma model; distressed older adults with lower MHL were more likely to have public stigma internalized as self-stigma, which then reduced their intentions to seek help. More specifically, low MHL magnified the negative effect of self-stigma on attitudes and intentions. CONCLUSIONS: These results increase our understanding of which older adults are less likely to seek mental health services: distressed older adults with poor MHL and high self-stigma. CLINICAL IMPLICATIONS: MHL is a malleable construct that can be targeted by interventions designed to increase help-seeking among distressed older adults in need of professional help.
RESUMO
OBJECTIVE: To estimate the prevalence of co-occurring pain sites among older adults with persistent back pain and associations of multisite pain with longitudinal outcomes. DESIGN: Secondary analysis of a cohort study. SETTING: Three integrated health systems in the United States. SUBJECTS: Eight hundred ninety-nine older adults with persistent back pain. METHODS: Participants reported pain in the following sites: stomach, arms/legs/joints, headaches, neck, pelvis/groin, and widespread pain. Over 18 months, we measured back-related disability (Roland Morris, scored 0-24), pain intensity (11-point numerical rating scale), health-related quality of life (EuroQol-5D [EQ-5D], utility from 0-1), and falls in the past three weeks. We used mixed-effects models to test the association of number and type of pain sites with each outcome. RESULTS: Nearly all (N = 839, 93%) respondents reported at least one additional pain site. There were 216 (24%) with one additional site and 623 (69%) with multiple additional sites. The most prevalent comorbid pain site was the arms/legs/joints (N = 801, 89.1%). Adjusted mixed-effects models showed that for every additional pain site, RMDQ worsened by 0.65 points (95% confidence interval [CI] = 0.43 to 0.86), back pain intensity increased by 0.14 points (95% CI = 0.07 to 0.22), EQ-5D worsened by 0.012 points (95% CI = -0.018 to -0.006), and the odds of falling increased by 27% (odds ratio = 1.27, 95% CI = 1.12 to 1.43). Some specific pain sites (extremity pain, widespread pain, and pelvis/groin pain) were associated with greater long-term disability. CONCLUSIONS: Multisite pain is common among older adults with persistent back pain. Number of pain sites was associated with all outcomes; individual pain sites were less consistently associated with outcomes.