Do Limited English Proficiency and Language Moderate the Relationship Between Mental Health and Pain?

Pain Manag Nurs. 2022 Aug;23(4):443-451. doi: 10.1016/j.pmn.2021.10.005. Epub 2021 Nov 22.


Aim: To explore whether the relationship between mental health diagnosis (i.e., mood or neurotic, stress-related, or somatoform disorder) and pain is moderated by language in patients with limited English proficiency (LEP). Southeast Asian languages (i.e., Hmong, Lao, Khmer) and Spanish were compared with English.

Method: A retrospective data mining study was conducted (n = 79,109 visits). Pain scores, language, mental health diagnoses, age, sex, race, ethnicity, and pain diagnosis were obtained from electronic medical records. Cragg two-equation hurdle regression explored: (1) the effect of patient language and mental health diagnosis on pain and (2) the interaction between language and mental health diagnosis on pain.

Results: Visits were primarily for female (62.45%), White (80.10%), not Hispanic/Latino (96.06%), and English-speaking (97.85%) patients. Spanish or Southeast Asian language increased chances of reporting any pain (i.e., pain score of 0 versus ≥1) and pain severity in visits with pain scores ≥1, whereas mental health diagnosis decreased chances of reporting any pain and pain severity. The combination of Southeast Asian language and mood disorder contributed to higher chances of reporting any pain (odds ratio [OR] = 1.78, p<.001) but no difference in severity. A similar trend was observed for Southeast Asian language and neurotic disorder (OR = 1.29, p=.143). In contrast, the combination of Spanish language and mood (p = .066) or neurotic (p = .289) disorder contributed to lower pain severity but did not change the chances of reporting any pain.

Conclusions: LEP and patient language should be considered during pain assessment within the context of mental health.

Keywords: Electronic health records; Language; Limited English Proficiency; Minority health; Pain.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Communication Barriers
  • Female
  • Humans
  • Language*
  • Limited English Proficiency*
  • Mental Health
  • Pain / complications
  • Retrospective Studies