Worry Among Latinx Young Adults: Relations to Pain Experience, Pain-Related Anxiety, and Perceived Health

  • Michael J. ZvolenskyEmail author
  • Brooke Y. Kauffman
  • Daniel Bogiaizian
  • Andres G. Viana
  • Jafar Bakhshaie
  • Andrew H. Rogers
  • Natalia Peraza
Original Paper


Latinx are one of the largest and most rapidly growing segments of the United States (U.S.) population that is significantly impacted by health disparities, including somatic health problems. Young Latinx adults (ages 18–25 years) are at a greater risk for being affected by such health inequalities and there is a need to understand individual-based differences that may contribute to and maintain somatic symptoms, including pain experience, pain beliefs, and perceptions of health. Thus, the current study investigated the explanatory role of worry in association between pain intensity, pain disability, pain-related anxiety, and perceived health among Latinx college students. Participants included 401 (Mage = 21 years; SD = 2.02; 83% female) Latinx students at a large, southwestern university. Results indicated that greater levels of worry were related to increased levels of pain intensity, pain disability, pain-related anxiety, and lower levels of perceived health. These findings were evident above and beyond variance accounted for by gender, age, physical functioning, and subjective social status. Overall, the results from the present investigation suggest that there is greater risk for more severe pain experiences, maladaptive beliefs regarding pain, and worse perceptions of health status among Latinx young adults who experience elevated levels of worry.


Latinx Young adults Pain Health Worry Pain-related anxiety 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Statement of Human Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


  1. 1.
    Stepler R, Brown A. Statistical portrait of Hispanics in the United States. Pew Research Center; 2016.Google Scholar
  2. 2.
    (HHS) USDoHaHS. Mental health: culture, race, and ethnicity: a supplement to mental health: a report of the surgeon general. 2001.Google Scholar
  3. 3.
    Alegria M, Canino G, Stinson FS, Grant BF. Nativity and DSM-IV psychiatric disorders among Puerto Ricans, Cuban Americans, and non-Latino Whites in the United States: results from the National Epidemiologic Survey on alcohol and related conditions. J Clin Psychiatry. 2006;67:56–65.Google Scholar
  4. 4.
    Hausmann LR, Jeong K, Bost JE, Ibrahim SA. Perceived discrimination in health care and health status in a racially diverse sample. Med Care. 2008;46(9):905–14.Google Scholar
  5. 5.
    Gagnon CM, Matsuura JT, Smith CC, Stanos SP. Ethnicity and interdisciplinary pain treatment. Pain Pract. 2014;14(6):532–40.Google Scholar
  6. 6.
    Canino G, Koinis-Mitchell D, Ortega AN, McQuaid EL, Fritz GK, Alegría M. Asthma disparities in the prevalence, morbidity, and treatment of Latino children. Soc Sci Med. 2006;63(11):2926–37.Google Scholar
  7. 7.
    Chartier K, Caetano R. Ethnicity and health disparities in alcohol research. Alcohol Res Health. 2010;33(1–2):152–60.Google Scholar
  8. 8.
    Blum RW. Young people: not as healthy as they seem. Lancet. 2009;374(9693):853–4.Google Scholar
  9. 9.
    West P. Health inequalities in the early years: is there equalisation in youth? Soc Sci Med. 1997;44(6):833–58.Google Scholar
  10. 10.
    Campo JV, Fritsch SL. Somatization in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1994;33(9):1223–35.Google Scholar
  11. 11.
    Fritz GK, Fritsch S, Hagino O. Somatoform disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. 1997;36(10):1329–38.Google Scholar
  12. 12.
    Garralda ME. Somatisation in children. J Child Psychol Psychiatry. 1996;37(1):13–33.Google Scholar
  13. 13.
    Garber J, Walker LS, Zeman J. Somatization symptoms in a community sample of children and adolescents: further validation of the Children’s Somatization Inventory. Psychol Assess. 1991;3(4):588–95.Google Scholar
  14. 14.
    Campo JV, Jansen-McWilliams L, Comer DM, Kelleher KJ. Somatization in pediatric primary care: association with psychopathology, functional impairment, and use of services. J Am Acad Child Adolesc Psychiatry. 1999;38(9):1093–101.Google Scholar
  15. 15.
    Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, et al. Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016. Morb Mortal Wkly Rep. 2018;67(36):1001–6.Google Scholar
  16. 16.
    Katz JN, Amick BC, Carroll BB, Hollis C, Fossel AH, Coley CM. Prevalence of upper extremity musculoskeletal disorders in college students. Am J Med. 2000;109(7):586–8.Google Scholar
  17. 17.
    Rateau MR. Use of backpacks in children and adolescents: a potential contributor of back pain. Orthop Nurs. 2004;23(2):101–5.Google Scholar
  18. 18.
    Green CR, Anderson KO, Baker TA, Campbell LC, Decker S, Fillingim RB, et al. The unequal burden of pain: confronting racial and ethnic disparities in pain. Pain Med. 2003;4(3):277–94.Google Scholar
  19. 19.
    Cintron A, Morrison RS. Pain and ethnicity in the United States: a systematic review. J Palliat Med. 2006;9(6):1454–73.Google Scholar
  20. 20.
    Hernandez A, Sachs-Ericsson N. Ethnic differences in pain reports and the moderating role of depression in a community sample of Hispanic and Caucasian participants with serious health problems. Psychosom Med. 2006;68(1):121–8.Google Scholar
  21. 21.
    Paulus DJ, Rodriguez-Cano R, Garza M, Ochoa-Perez M, Lemaire C, Bakhshaie J, et al. Acculturative stress and alcohol use among Latinx recruited from a primary care clinic: moderation by emotion dysregulation. Am J Orthopsychiatry. in press.Google Scholar
  22. 22.
    Edwards RR, Moric M, Husfeldt B, Buvanendran A, Ivankovich O. Ethnic similarities and differences in the chronic pain experience: a comparison of African American, Hispanic, and white patients. Pain Med. 2005;6(1):88–98.Google Scholar
  23. 23.
    Simon GE, VonKorff M, Piccinelli M, Fullerton C, Ormel J. An international study of the relation between somatic symptoms and depression. N Engl J Med. 1999;341(18):1329–35.Google Scholar
  24. 24.
    Idler EL, Kasl S. Health perceptions and survival: do global evaluations of health status really predict mortality? J Gerontol. 1991;46(2):S55–65.Google Scholar
  25. 25.
    Idler EL, Angel RJ. Self-rated health and mortality in the NHANES-I Epidemiologic Follow-up Study. Am J Public Health. 1990;80(4):446–52.Google Scholar
  26. 26.
    Schmidt NB, Telch MJ, Joiner TE Jr. Factors influencing health perceptions in patients with panic disorder. Compr Psychiatry. 1996;37(4):253–60.Google Scholar
  27. 27.
    Cheung FK, Snowden LR. Community mental health and ethnic minority populations. Community Ment Health J. 1990;26(3):277–91.Google Scholar
  28. 28.
    Cortés DE, Gerena M, Canino G, Aguilar-Gaxiola S, Febo V, Magaña C, et al. Translation and cultural adaptation of a mental health outcome measure: the Basis-R©. Cult Med Psychiatry. 2007;31(1):25–49.Google Scholar
  29. 29.
    Borkovec TD, Alcaine O, Behar E. Avoidance theory of worry and generalized anxiety disorder. Generalized anxiety disorder: advances in research and practice. New York; 2004.Google Scholar
  30. 30.
    Borkovec T. The nature, functions, and origins of worry. Sussex: Wiley; 1994.Google Scholar
  31. 31.
    Mennin DS, Heimberg RG, Turk CL, Fresco DM. Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clin Psychol Sci Pract. 2002;9(1):85–90. Scholar
  32. 32.
    Carter RM, Wittchen HU, Pfister H, Kessler RC. One-year prevalence of subthreshold and threshold DSM-IV generalized anxiety disorder in a nationally representative sample. Depress Anxiety. 2001;13(2):78–88.Google Scholar
  33. 33.
    Borkovec TD, Ray WJ, Worry SJ. A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cogn Ther Res. 1998;22(6):561–76. Scholar
  34. 34.
    Street L, Salman E, Garfinkle R, Silvestri J, Carrasco J, Cardenas D, et al. Discriminating between generalized anxiety disorder and anxiety disorder not otherwise specified in a Hispanic population: is it only a matter of worry? Depress Anxiety. 1997;5:1–6.Google Scholar
  35. 35.
    Vega WA, Kolody B, Aguilar-Gaxiola S, Alderete E, Catalano R, Caraveo-Anduaga J. Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California. Arch Gen Psychiatry. 1998;55(9):771–8. Scholar
  36. 36.
    McLaughlin KA, Hilt LM, Nolen-Hoeksema S. Racial/ethnic differences in internalizing and externalizing symptoms in adolescents. J Abnorm Child Psychol. 2007;35(5):801–16. Scholar
  37. 37.
    Ginsburg GS, Silverman WK. Phobic and anxiety disorders in Hispanic and Caucasian youth. J Anxiety Disord. 1996;10(6):517–28. Scholar
  38. 38.
    Varela RE, Vernberg EM, Sanchez-Sosa JJ, Riveros A, Mitchell M, Mashunkashey J. Anxiety reporting and culturally associated interpretation biases and cognitive schemas: a comparison of Mexican, Mexican American, and European American families. J Clin Child Adolesc Psychol. 2004;33(2):237–47. Scholar
  39. 39.
    Silverman WK, La Greca AM, Wasserstein S. What do children worry about? Worries and their relation to anxiety. Child Dev. 1995;66(3):671–86. Scholar
  40. 40.
    Von Korff M, Ormel J, Keefe FJ, Dworkin SF. Grading the severity of chronic pain. Pain. 1992;50(2):133–49.Google Scholar
  41. 41.
    McCracken LM, Zayfert C, Gross RT. The pain anxiety symptoms scale: development and validation of a scale to measure fear of pain. Pain. 1992;50(1):67–73.Google Scholar
  42. 42.
    Stewart AL, Hays RD, Ware JE Jr. The MOS short-form general health survey. Reliability and validity in a patient population. Med Care. 1988;26(7):724–35.Google Scholar
  43. 43.
    Niles AN, Dour HJ, Stanton AL, Roy-Byrne PP, Stein MB, Sullivan G, et al. Anxiety and depressive symptoms and medical illness among adults with anxiety disorders. J Psychosom Res. 2015;78(2):109–15. Scholar
  44. 44.
    Zvolensky MJ, Paulus DJ, Bakhshaie J, Garza M, Valdivieso J, Ochoa-Perez M, et al. Anxiety sensitivity and rumination: transdiagnostic factors involved in the relation between subjective social status and anxiety and depressive symptoms and disorders among economically disadvantaged Latinos in primary care. Am J Orthopsychiatry. 2018;88(5):571–81. Scholar
  45. 45.
    Monroe CM, Thomas DQ, Lagally K, Cox A. Relation of college students’ self-perceived and measured health-related physical fitness. Percept Mot Skills. 2010;111(1):229–39. Scholar
  46. 46.
    Sánchez M, Cardemil E, Adams ST, Calista JL, Connell J, DePalo A, et al. Brave new world: mental health experiences of Puerto Ricans, immigrant Latinos, and Brazilians in Massachusetts. Cult Divers Ethn Minor Psychol. 2014;20(1):16–26. Scholar
  47. 47.
    Biddle SJ, Fox K, Boutcher S. Physical activity and psychological well-being. Routledge; 2003.Google Scholar
  48. 48.
    Meyer TJ, Miller ML, Metzger RL, Borkovec TD. Development and validation of the Penn State Worry Questionnaire. Behav Res Ther. 1990;28(6):487–95.Google Scholar
  49. 49.
    Behar E, Alcaine O, Zuellig AR, Borkovec TD. Screening for generalized anxiety disorder using the Penn State Worry Questionnaire: a receiver operating characteristic analysis. J Behav Ther Exp Psychiatry. 2003;34(1):25–43.Google Scholar
  50. 50.
    Brown TA, Antony MM, Barlow DH. Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behav Res Ther. 1992;30(1):33–7.Google Scholar
  51. 51.
    Fresco DM, Mennin DS, Heimberg RG, Turk CL. Using the Penn State Worry Questionnaire to identify individuals with generalized anxiety disorder: a receiver operating characteristic analysis. J Behav Ther Exp Psychiatry. 2003;34(3–4):283–91. Scholar
  52. 52.
    Smith BH, Penny KI, Purves AM, Munro C, Wilson B, Grimshaw J, et al. The chronic pain grade questionnaire: validation and reliability in postal research. Pain. 1997;71(2):141–7.Google Scholar
  53. 53.
    Rogers AH, Bakhshaie J, Viana AG, Lemaire C, Garza M, Ochoa-Perez M, et al. The explanatory role of insomnia in the relationship between pain intensity and posttraumatic stress symptom severity among trauma-exposed Latinos in a federally qualified health center. J Racial Ethn Health Disparities. 2018;5:1389–96. Scholar
  54. 54.
    Rogers AH, Bakhshaie J, Lam H, Langdon KJ, Ditre JW, Zvolensky MJ. Pain-related anxiety and opioid misuse in a racially/ethnically diverse young adult sample with moderate/severe pain. Cogn Behav Ther. 2018;47:1–11. Scholar
  55. 55.
    Von Korff M. Epidemiological and survey methods: assessment of chronic pain. 2 ed. Handbook of pain assessment. New York: Guilford Press; 2001.Google Scholar
  56. 56.
    Adler NE. Health disparities through a psychological lens. Am Psychol. 2009;64(8):663–73. Scholar
  57. 57.
    Franzini L, Fernandez-Esquer ME. The association of subjective social status and health in low-income Mexican-origin individuals in Texas. Soc Sci Med. 2006;63(3):788–804. Google Scholar
  58. 58.
    Ostrove JM, Adler NE, Kuppermann M, Washington AE. Objective and subjective assessments of socioeconomic status and their relationship to self-rated health in an ethnically diverse sample of pregnant women. Health Psychol. 2000;19(6):613–8.Google Scholar
  59. 59.
    Reitzel LR, Kendzor DE, Cao Y, Businelle MS. Subjective social status predicts quit-day abstinence among homeless smokers. Am J Health Promot. 2014;29(1):43–5. Scholar
  60. 60.
    Adler N, Singh-Manoux A, Schwartz J, Stewart J, Matthews K, Marmot MG. Social status and health: a comparison of British civil servants in Whitehall-II with European- and African-Americans in CARDIA. Soc Sci Med. 2008;66(5):1034–45. Google Scholar
  61. 61.
    Zorotovich J, Johnson EI, Linn R. Subjective social status and positive indicators of well-being among emerging adult college students. Coll Stud J. 2016;50(4):624–35.Google Scholar
  62. 62.
    La Greca AM, Harrison HM. Adolescent peer relations, friendships, and romantic relationships: do they predict social anxiety and depression? J Clin Child Adolesc Psychol. 2005;34(1):49–61. Scholar
  63. 63.
    Reef J, Diamantopoulou S, van Meurs I, Verhulst FC, van der Ende J. Developmental trajectories of child to adolescent externalizing behavior and adult DSM-IV disorder: results of a 24-year longitudinal study. Soc Psychiatry Psychiatr Epidemiol. 2011;46(12):1233–41. Scholar
  64. 64.
    Barlow DH, Blanchard EB, Vermilyea JA, Vermilyea BB, DiNardo PA. Generalized anxiety and generalized anxiety disorder: description and reconceptualization. Am J Psychiatry. 1986;143(1):40–4. Scholar
  65. 65.
    Bankier B, Januzzi JL, Littman AB. The high prevalence of multiple psychiatric disorders in stable outpatients with coronary heart disease. Psychosom Med. 2004;66(5):645–50.Google Scholar
  66. 66.
    Barger SD, Sydeman SJ. Does generalized anxiety disorder predict coronary heart disease risk factors independently of major depressive disorder? J Affect Disord. 2005;88(1):87–91.Google Scholar
  67. 67.
    Borkovec TD, Inz J. The nature of worry in generalized anxiety disorder: a predominance of thought activity. Behav Res Ther. 1990;28(2):153–8. Scholar
  68. 68.
    Phillips AC, Batty GD, Gale CR, Deary IJ, Osborn D, MacIntyre K, et al. Generalized anxiety disorder, major depressive disorder, and their comorbidity as predictors of all-cause and cardiovascular mortality: the Vietnam experience study. Psychosom Med. 2009;71(4):395–403.Google Scholar
  69. 69.
    Dugas MJ, Letarte H, Rhéaume J, Freeston MH, Ladouceur R. Worry and problem solving: evidence of a specific relationship. Cogn Ther Res. 1995;19(1):109–20. Scholar
  70. 70.
    Wells A. Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behav Cogn Psychother. 1995;23(3):301–20. Scholar
  71. 71.
    Wilcox S, Ainsworth BE, LaMonte MJ, DuBose KD. Worry regarding major diseases among older African-American, Native-American, and Caucasian women. Women Health. 2002;36(3):83–99.Google Scholar
  72. 72.
    Dugas MJ, Freeston MH, Ladouceur R. Intolerance of uncertainty and problem orientation in worry. Cogn Ther Res. 1997;21(6):593–606. Scholar
  73. 73.
    Roemer L, Orsillo SM. Expanding our conceptualization of and treatment for generalized anxiety disorder: integrating mindfulness/acceptance-based approaches with existing cognitive-behavioral models. Clin Psychol Sci Pract. 2002;9(1):54–68. Scholar
  74. 74.
    Starcevic V. Pathological worry in major depression: a preliminary report. Behav Res Ther. 1995;33(1):55–6. Scholar
  75. 75.
    Startup HM, Erickson TM. The Penn State Worry Questionnaire (PSWQ). In: Davey GCL, Wells A, editors. Worry and its psychological disorders: theory, assessment and treatment. Hoboken: Wiley Publishing; 2006. p. 101–19.Google Scholar
  76. 76.
    Robichaud M, Dugas MJ. A cognitive-behavioral treatment targeting intolerance of uncertainty. In: Davey GCL, Wells A, editors. Worry and its psychological disorders: theory, assessment and treatment. Hoboken: Wiley Publishing; 2006. p. 289–304.Google Scholar
  77. 77.
    Mennin DS. Emotion regulation therapy for generalized anxiety disorder. Clin Psychol Psychother. 2004;11(1):17–29. Scholar
  78. 78.
    Roemer L, Orsillo SM. An acceptance-based behavior therapy for generalized anxiety disorder. In: Orsillo SM, Roemer L, editors. Acceptance and mindfulness-based approaches to anxiety: conceptualization and treatment. Series in anxiety and related disorders. New York: Springer Science + Business Media; 2005. p. 213–40.Google Scholar
  79. 79.
    Jaworska S, Ryan K. Gender and the language of pain in chronic and terminal illness: a corpus-based discourse analysis of patients’ narratives. Soc Sci Med. 2018;215:107–14. Scholar
  80. 80.
    Miller C, Newton SE. Pain perception and expression: the influence of gender, personal self-efficacy, and lifespan socialization. Pain Manag Nurs. 2006;7(4):148–52. Google Scholar
  81. 81.
    Moore A, Grime J, Campbell P, Richardson J. Troubling stoicism: sociocultural influences and applications to health and illness behaviour. Health (London). 2013;17(2):159–73. Scholar
  82. 82.
    Bernardes SF, Silva SA, Carvalho H, Costa M, Pereira S. Is it a (fe)male pain? Portuguese nurses’ and laypeople’s gendered representations of common pains. Eur J Pain. 2014;18(4):530–9. Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Department of PsychologyUniversity of HoustonHoustonUSA
  2. 2.Department of Behavioral ScienceThe University of Texas MD Anderson Cancer CenterHoustonUSA
  3. 3.HEALTH InstituteUniversity of HoustonHoustonUSA
  4. 4.Psychotherapeutic Area of Asociación AyudaAnxiety Disorders ClinicBuenos AiresArgentina

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