Substitution of Nonpharmacologic Therapy With Opioid Prescribing for Pain During the COVID-19 Pandemic.

Importance: During the pandemic, access to medical care unrelated to COVID-19 was limited because of concerns about viral spread and corresponding policies. It is critical to assess how these conditions affected modes of pain treatment, given the addiction risks of prescription opioids. Objective: To assess the trends in opioid prescription and nonpharmacologic therapy (ie, physical therapy and complementary medicine) for pain management during the COVID-19 pandemic in 2020 compared with the patterns in 2019. Design, Setting, and Participants: This retrospective, cross-sectional study used weekly claims data from 24 million US patients in a nationwide commercial insurance database (Optum's deidentified Clinformatics Data Mart Database) from January 1, 2019, to September 31, 2020. Among patients with diagnoses of limb, extremity, or joint pain, back pain, and neck pain for each week, patterns of treatment use were identified and evaluated. Data analysis was performed from April 1, 2021, to September 31, 2021. Main Outcomes and Measures: The main outcomes of interest were weekly rates of opioid prescriptions, the strength and duration of related opioid prescriptions, and the use of nonpharmacologic therapy. Transition rates between different treatment options before the outbreak and during the early months of the pandemic were also assessed. Results: A total of 21 430 339 patients (mean [SD] age, 48.6 [24.0] years; 10 960 507 [51.1%] female; 909 061 [4.2%] Asian, 1 688 690 [7.9%] Black, 2 276 075 [10.6%] Hispanic, 11 192 789 [52.2%] White, and 5 363 724 [25.0%] unknown) were enrolled during the first 3 quarters in 2019 and 20 759 788 (mean [SD] age, 47.0 [23.8] years; 10 695 690 [51.5%] female; 798 037 [3.8%] Asian; 1 508 023 [7.3%] Black, 1 976 248 [9.5%] Hispanic, 10 059 597 [48.5%] White, and 6 417 883 [30.9%] unknown) in the first 3 quarters of 2020. During the COVID-19 pandemic, the proportion of patients receiving a pain diagnosis was smaller than that for the same period in 2019 (mean difference, -15.9%; 95% CI, -16.1% to -15.8%). Patients with pain were more likely to receive opioids (mean difference, 3.5%; 95% CI, 3.3%-3.7%) and less likely to receive nonpharmacologic therapy (mean difference, -6.0%; 95% CI, -6.3% to -5.8%), and opioid prescriptions were longer and more potent during the early pandemic in 2020 relative to 2019 (mean difference, 1.07 days; 95% CI, 1.02-1.17 days; mean difference, 0.96 morphine milligram equivalents; 95% CI, 0.76-1.20). Analysis of individuals' transitions between treatment options for pain found that patients were more likely to transition out of nonpharmacologic therapy, replacing it with opioid prescriptions for pain management during the COVID-19 pandemic than in the year before. Conclusions and Relevance: Nonpharmacologic therapy is a benign treatment for pain often recommended instead of opioid therapy. The decrease in nonpharmacologic therapy and increase in opioid prescription during the COVID-19 pandemic found in this cross-sectional study, especially given longer days of prescription and more potent doses, may exacerbate the US opioid epidemic. These findings suggest that it is imperative to investigate the implications of limited medical access on treatment substitution, which may increase patient risk, and implement policies and guidelines to prevent those substitutions.

Maternal Differential Treatment and Psychological Well-Being: The Mediating Role of Marital Tension and Sibling Tension?

OBJECTIVES: Past research used equity theory and social comparison theory to explain the direct effect of maternal differential treatment (MDT) on psychological well-being. However, this focus on psychological pathways ignores possible social pathways, such as indirect effects of MDT on well-being through disrupting other family relationships. This study uses stress proliferation theory to argue that MDT, as a primary stressor in mother-child relationships, can produce secondary stressors in other family relationships (e.g., sibling tension and marital tension), which in turn leads to lower psychological well-being. METHODS: To investigate this mechanism, we conducted multilevel mediation analysis using data collected from 720 adult children nested within 308 families, as part of the Within-Family Differences Study. RESULTS: We found that sibling tension mediates the association between adult children's perceptions of maternal disfavoritism and their psychological well-being-a process we call the stress proliferation of maternal disfavoritism. In contrast, adult children's perceptions of maternal favoritism cannot trigger this stress proliferation process of producing marital tension nor sibling tension. DISCUSSION: The evaluation of the stress proliferation process of maternal favoritism and disfavoritism can help us to understand the difference in effects across various dimensions of MDT. This study contributes to the literature on social relationships as social determinants of health by investigating how intergenerational relationships are connected to other family relationships to affect family members' health.

Older mother's health and adult children's education: Conceptualization of adult children's education and mother-child relationships.

This study joins and extends an emerging body of work examining the association between adult children's education and their parents' health by (1) providing a conceptual treatment of adult children's education, (2) examining the link between adult children's education and older mothers' physical and mental health, and (3) investigating whether mother-child relationships moderate the association between children's education and mothers' health. Data on 541 older mothers in the U.S. who reported on all of their adult children collected as part of the Within-Family Differences Study. Results indicate the best performing measure of adult children's education, the proportion with a college degree or higher, reflects a cumulative, credential-based approach. In addition, the proportion of adult children with a college degree or higher maintains a negative association with mother's depressive symptoms and activity limitations net of mother's own education as well as a number of sociodemographic factors and adult children's measures. There was no evidence that various aspects of mother-child relationships (geographic proximity, frequency of contact, and quality of relationships) moderated these negative associations.

Conflict with Mothers and Siblings During Caregiving: Differential Costs for Black and White Adult Children.

Objectives: Family conflict has been found to play a role in caregivers' psychological well-being; however, few studies have considered race differences in the prevalence and consequences of caregiving conflict. In this paper, we use mixed-methods to examine differences in the experiences of conflict among Black and White adult children caring for mothers. Methods: Quantitative and qualitative data were collected from 279 adult-child caregivers (213 White; 66 Black). Results: Multilevel modeling revealed that conflict with mothers predicted depressive symptoms among Black, but not White caregivers, whereas there were not statistically significant race differences in the effects of conflict with siblings. However within-model tests showed stronger effects of conflict with mothers than siblings for Black caregivers, and stronger effects of conflict with siblings than mothers for White caregivers. Qualitative data revealed that Black caregivers' conflict with mothers resulted from their inability to meet their mothers' needs, inducing concern and sadness. White children's conflict stemmed from mothers' resistance to unwanted assistance and requests for support that children considered excessive, evoking irritation and frustration. Discussion: This study highlights ways in which the experiences of caregivers reflect broader patterns of differences between Black and White families in both intergenerational cohesion and health disparities in midlife.

The Long Arm of Maternal Differential Treatment: Effects of Recalled and Current Favoritism on Adult Children's Psychological Well-Being.

Objectives: In this article, we draw from classic theories of social psychology and the life course to compare the effects of current and recalled perceived maternal differential treatment (MDT) on the depressive symptoms of adult children in midlife. Method: To address this question, we used data collected from 746 adult children nested within 293 later-life families as part of the Within-Family Differences Study. Results: Multilevel regression revealed that both recollections of maternal differentiation from childhood and perceptions of mothers' current disfavoritism regarding conflict predicted depressive symptoms, whereas perceptions of current favoritism regarding emotional closeness did not. Discussion: Taken together, the findings from this investigation reflect principles of theories of social comparison and the life course in that both perceptions of current MDT and MDT recalled from childhood affect children's well-being in midlife. These findings contribute to a growing body of literature highlighting the role of within-family differences in parent-child relationships on well-being across the life course.

Role of Perceived Maternal Favoritism and Disfavoritism in Adult Children's Psychological Well-Being.

OBJECTIVES: The detrimental consequences of parents' differential treatment on children's well-being have been documented in earlier stages of the life course; however, little is known about this pattern in midlife. Drawing from theories of equity and social comparison, we tested whether psychological well-being was affected only by adult children's perceptions that their mothers treated some offspring in the family differently or by their perceptions that they were favored or disfavored. Further, we explored the extent to which these patterns differed by race. METHOD: Multilevel regression modeling was conducted using data collected from 725 adult children nested within 309 later-life families as part of the Within-Family Differences Study-II. RESULTS: Depressive symptoms were higher when offspring perceived that they had the most emotional closeness to mothers or the greatest conflict with mothers. Depressive symptoms were also higher when respondents identified themselves as being the children in whom the mothers were most disappointed. DISCUSSION: The findings shed new light on the role of intergenerational relations in adult children's well-being in midlife by taking into consideration the respondents' direct reports of their perceptions of their mothers' favoritism and disfavoritism. Further, the findings provide evidence that the association between maternal differentiation and psychological well-being in adulthood is stronger in Black than in White families. These patterns suggest that the association between psychological well-being and both favoritism and disfavoritism can be accounted for by processes involving social comparison rather than equity for both Black and White adult children in midlife.