• Melissa M Buttner, Kathryn M Godfrey, Elizabeth Floto, James Pittman, Laurie Lindamer, and Niloofar Afari.
• VA Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System, San Diego, CA, USA; Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.
• Psychiatry Res. 2017 Nov 1; 257: 7-13.

AbstractVeterans experience physical health problems associated with disability and poor quality of life following combat exposure (CE). Understanding the CE-physical health relationship, specifically pain intensity and somatic pain, may inform etiological models and interventions. This study examined the CE-pain relationship, associated mediators, and gender as a moderator. 2381 veterans at the VA San Diego Healthcare System completed paper or electronic self-report measures of pain intensity and somatic pain. Analyses examined associations of pain with CE and posttraumatic stress disorder (PTSD), depression, and resilience as mediators of the CE-pain association. Moderated mediation models explored gender as a moderator of significant mediated pathways. Controlling for age, veterans with CE had significantly higher pain intensity and somatic pain, and PTSD and depression scores significantly mediated the CE-pain relationships. Gender significantly moderated the CE-pain intensity association through depression scores such that the indirect effect was stronger for female veterans relative to male veterans. CE is associated with pain intensity and somatic pain, with greater levels of PTSD and depression mediating the CE-pain link and gender moderating the depression mediated CE-pain association. Future studies should examine gender differences and mediators in the CE-pain relationships using longitudinal designs to inform etiological models and targeted pain interventions.Published by Elsevier B.V.

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