The Impact of Pain on Insomnia, Depression, and Loneliness Among Southern California Veterans

Background and Purpose: It is well established that expericing pain can have deleterious impacts on well-being. Veterans have increased susceptibility to challenges with pain due to impact of military service demands on the body (Nahin, 2017). Little attention has been given to the experiences of these challenges within this population, with most studies available exploring pain in relation to access to care or its impact on PTSD. The purpose of this study was to expand the exploration of the relationship between pain and well-being in veterans by examining the impact of pain on sleep, depression and loneliness.

Methods: Data were collected from 3,188 Southern California Veterans. Potential participants received an invitation to participate in the study and were provided with a link to complete the survey online. The survey took approximately 30-60 minutes. Participants received a $25 gift card. Respondents completed valid and reliable measures of pain (NPRS; Ferraz et al., 1990), loneliness (Three Item Loneliness Measure; Hughes et al, 2004), depression (PhQ-9; Kroenke et al., 2002) and sleep problems (ISI; Bastien et al., 2001). A series of chi-square analysis were performed to test for associations between pain and each outcome variable. The bivariate analysis was repeated using background variables and PTSD (PCL-5-SF; Zuromski et al, 2019) to identify potential control variables. Significant variables were then included in a multivariate regression analysis on the outcomes of loneliness, depression and insomnia.

Results: Bivariate results found moderate/severe pain to be a significant predictor of all three outcome variables. PTSD, sex, age, race, ethnicity, education, marital status and officer status also predicted all outcomes. Additionally, deployments predicted depression but not loneliness and insomnia. Multivariate analyses revealed moderate/severe pain remained a significant predictor of insomnia, depression and loneliness. PTSD and female sex were significant predictors of all outcomes while being married and older were associated with lower odds of all outcomes, with employment related to lower odds of insomnia and employment and graduate degree related to lower odds of depression.

Conclusion and Implications: Pain was demonstrated to be a significant predictor of depression, loneliness and insomnia. Findings suggest that addressing issues of pain could create meaningful improvement to well-being in veterans. Despite the prominence of pain issues in this population, many veteran service organizations fail to assess pain challenges and lack resources and referrals for addressing such challenges. Improvements in assessment, screening and treatment of pain may be essential for addressing many well-being issues veterans face and increasing the likelihood of positive outcomes. Research should continue to expand the exploration of the role pain may play in the well-being of veterans.