Social Support, Social Cohesion and Pain during Pregnancy: The Japan Environment and Children’s Study.
Persistent pain during pregnancy is a significant health issue, which could be correlated with psychological distress resulting from inadequate social support. This study aims to investigate whether the relationship between poor social support and antenatal pain is mediated by psychological distress. We also aimed to examine whether social cohesion moderates the influence of psychological distress on the relationship between social support and antenatal pain.We analyzed 94,517 pregnancies of women from a Japanese national birth cohort completed questionnaires assessing pain, social support, social cohesion, and psychological distress. Psychological distress was assessed using the Kessler Psychological Distress Scale. Two types of models were used: the mediation model to examine whether the association between social support and pain was mediated by psychological distress; the moderated mediation model to analyze whether social cohesion buffered the negative effect of inadequate social support on pain. Demographic, socioeconomic, psychological, factors were controlled for in all analyses.The association between social support and pain mediated by psychological distress was 75.8%. Social cohesion had a focal moderation effect on the inverse association between social support and psychological distress (unstandardized regression coefficient [β] = 0.09; 95% CI, 0.07-0.11) and functioned as moderator for the indirect effect of social support on antenatal pain (index of moderated mediation = 0.006; 95% CI, 0.004-0.007).Poor social support was related to antenatal pain through psychological distress, possibly buffered by social cohesion. During the antenatal period, social support and cohesion are important for women.