Journal of Behavioral Medicine

, Volume 38, Issue 6, pp 944–955 | Cite as

The effects of daily mood and couple interactions on the sleep quality of older adults with chronic pain

  • Sunmi SongEmail author
  • Jennifer E. Graham-Engeland
  • Jacqueline Mogle
  • Lynn M. Martire


We examined the effect of daily negative and positive mood on the sleep quality of knee osteoarthritis (OA) patients (N = 152) and whether a partner’s daily responses to a patient’s pain behaviors moderated these associations. Patients and their partners completed a baseline interview and 22 daily diary assessments. After controlling for demographic characteristics, OA severity, comorbidities, medication use, relationship satisfaction, and depressed mood, multilevel modeling analyses demonstrated main effects of negative and positive mood on sleep quality indicators. Mood and partner responses interacted such that high solicitous and punishing responses strengthened the association between negative mood and worse sleep. Further, high solicitous responses increased the degree of association between low positive mood and poor sleep, and empathic responses combined with positive mood were associated with better sleep. Results demonstrate that daily negative and positive mood fluctuations can interact with partner responses to affect sleep quality among older adults with chronic pain.


Daily diary Mood Couple interactions Sleep quality Chronic pain 



The present study was supported by the National Institutes of Health R01 AG026010 (L. M. Martire). The first author is currently a postdoctoral fellow at the Social and Behavioral Research Branch at the National Human Genome Research Institute and was supported by a Kligman Graduate Fellowship via the College of Health and Human Development at The Pennsylvania State University (S. Song).

Conflict of interest

The authors declare that they have no conflict of interest.

Human and animal rights and Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committees on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent for inclusion in the study was obtained from all patients and their partners.


  1. Affleck, G., Tennen, H., Urrows, S., & Higgins, P. (1994). Person and contextual features of daily stress reactivity: Individual differences in relations of undesirable daily events with mood disturbance and chronic pain intensity. Journal of Personality and Social Psychology, 66, 329–340.CrossRefPubMedGoogle Scholar
  2. Åkerstedt, T., Hume, K., Minors, D., & Waterhouse, J. (1994). The subjective meaning of good sleep, an intraindividual approach using the Karolinska Sleep Diary. Perceptual and Motor Skills, 79, 287–296.CrossRefPubMedGoogle Scholar
  3. Åkerstedt, T., Hume, K. E. N., Minors, D., & Waterhouse, J. I. M. (1997). Good sleep—Its timing and physiological sleep characteristics. Journal of Sleep Research, 6, 221–229.CrossRefPubMedGoogle Scholar
  4. Alsaadi, S. M., McAuley, J. H., Hush, J. M., Bartlett, D. J., Henschke, N., Grunstein, R. R., & Maher, C. G. (2013). Detecting insomnia in patients with low back pain: Accuracy of four self-report sleep measures. BMC Musculoskeletal Disorders, 14, 196–205.PubMedCentralCrossRefPubMedGoogle Scholar
  5. Alsaadi, S. M., McAuley, J. H., Hush, J. M., Lo, S., Bartlett, D. J., Grunstein, R. R., & Maher, C. G. (2014). The bidirectional relationship between pain intensity and sleep disturbance/quality in patients with low back pain. Clinical Journal of Pain, 30, 755–765.CrossRefPubMedGoogle Scholar
  6. Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). American Journal of Preventive Medicine, 10, 77–84.PubMedGoogle Scholar
  7. Arden, N., & Nevitt, M. C. (2006). Osteoarthritis: Epidemiology. Best Practice & Research Clinical Rheumatology, 20, 3–25.CrossRefGoogle Scholar
  8. Bellamy, N., Buchanan, W. W., Goldsmith, C. H., Campbell, J., & Stitt, L. W. (1988). Validation study of WOMAC: A health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. Journal of Rheumatology, 15, 1833–1840.PubMedGoogle Scholar
  9. Bolger, N., Zuckerman, A., & Kessler, R. C. (2000). Invisible support and adjustment to stress. Journal of Personality and Social Psychology, 79, 953.CrossRefPubMedGoogle Scholar
  10. Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh sleep quality index: A new instrument for psychiatric practice and research. Psychiatry Research, 28, 193–213.CrossRefPubMedGoogle Scholar
  11. Campbell, P., Tang, N., McBeth, J., Lewis, M., Main, C. J., Croft, P. R., & Dunn, K. M. (2013). The role of sleep problems in the development of depression in those with persistent pain: A prospective cohort study. Sleep, 36, 1693–1698.PubMedCentralPubMedGoogle Scholar
  12. Cano, A., Barterian, J. A., & Heller, J. B. (2008). Empathic and nonempathic interaction in chronic pain couples. Clinical Journal of Pain, 24, 678–684.PubMedCentralCrossRefPubMedGoogle Scholar
  13. Cano, A., Johansen, A. B., & Geisser, M. (2004). Spousal congruence on disability, pain, and spouse responses to pain. Pain, 109, 258–265.PubMedCentralCrossRefPubMedGoogle Scholar
  14. Cano, A., Weisberg, J. N., & Gallagher, R. M. (2000). Marital satisfaction and pain severity mediate the association between negative spouse responses to pain and depressive symptoms in a chronic pain patient sample. Pain Medicine, 1, 35–43.CrossRefPubMedGoogle Scholar
  15. Cano, A., & Williams, A Cd C. (2010). Social interaction in pain: Reinforcing pain behaviors or building intimacy? Pain, 149, 9–11.PubMedCentralCrossRefPubMedGoogle Scholar
  16. Chien, K.-L., Chen, P.-C., Hsu, H.-C., Su, T.-C., Sung, F.-C., Chen, M.-F., & Lee, Y.-T. (2010). Habitual sleep duration and insomnia and the risk of cardiovascular events and all-cause death: Report from a community-based cohort. Sleep, 33, 177–184.PubMedCentralPubMedGoogle Scholar
  17. Cohen, S. (2004). Social relationships and health. The American Psychologist, 59, 676–684.CrossRefPubMedGoogle Scholar
  18. Davis, M. C., Thummala, K., & Zautra, A. J. (2014). Stress-related clinical pain and mood in women with chronic pain: Moderating effects of depression and positive mood induction. Annals of Behavioral Medicine, 48, 61–70. doi: 10.1007/s12160-013-9583-6 PubMedCentralCrossRefPubMedGoogle Scholar
  19. Feldman, S. I., Downey, G., & Schaffer-Neitz, R. (1999). Pain, negative mood, and perceived support in chronic pain patients: A daily diary study of people with reflex sympathetic dystrophy syndrome. Journal of Consulting and Clinical Psychology, 67, 776–785.CrossRefPubMedGoogle Scholar
  20. Flor, H., Turk, D. C., & Rudy, T. E. (1989). Relationship of pain impact and significant other reinforcement of pain behaviors: The mediating role of gender, marital status and marital satisfaction. Pain, 38, 45–50.CrossRefPubMedGoogle Scholar
  21. Goubert, L., Craig, K. D., Vervoort, T., Morley, S., Sullivan, M. J. L., Williams, A Cd C, et al. (2005). Facing others in pain: The effects of empathy. Pain, 118, 285–288.CrossRefPubMedGoogle Scholar
  22. Hamilton, N. A., Karlson, C., Luxton, D., Preacher, K. J., Templin, J. L., Affleck, G., & Tennen, H. (2008). Fibromyalgia: The role of sleep in affect and in negative event reactivity and recovery. Health Psychology, 27, 490–497. doi: 10.1037/0278-6133.27.4.490 CrossRefPubMedGoogle Scholar
  23. Hawker, G. A., French, M. R., Waugh, E. J., Gignac, M. A. M., Cheung, C., & Murray, B. J. (2010). The multidimensionality of sleep quality and its relationship to fatigue in older adults with painful osteoarthritis. Osteoarthritis and Cartilage, 18, 1365–1371.CrossRefPubMedGoogle Scholar
  24. Hawker, G. A., Wright, J. G., Coyte, P. C., Williams, J. I., Harvey, B., Glazier, R., & Badley, E. M. (2000). Differences between men and women in the rate of use of hip and knee arthroplasty. New England Journal of Medicine, 342, 1016–1022.CrossRefPubMedGoogle Scholar
  25. Hedeker, D., Demirtas, H., & Mermelstein, R. J. (2009). A mixed ordinal location scale model for analysis of Ecological Momentary Assessment (EMA) data. Statistics and its Interface, 2, 391–401.PubMedCentralCrossRefPubMedGoogle Scholar
  26. Joiner, T. E., & Timmons, K. A. (2009). Depression in its interpersonal context. In I. H. Gotlib & C. Hammen (Eds.), Handbook of depression (pp. 322–340). New York, NY: The Guilford Press.Google Scholar
  27. Kawada, T. (2012). Feeling refreshed by sleep can predict psychological wellbeing assessed using the General Health Questionnaire in male workers: A 3-year follow-up study. Psychiatry Investigation, 9, 418–421.PubMedCentralCrossRefPubMedGoogle Scholar
  28. Kerns, R. D., Haythornthwaite, J., Southwick, S., & Giller, E. L. (1990). The role of marital interaction in chronic pain and depressive symptom severity. Journal of Psychosomatic Research, 34, 401–408.CrossRefPubMedGoogle Scholar
  29. Kerns, R. D., Turk, D. C., & Rudy, T. E. (1985). The west haven-yale multidimensional pain inventory (WHYMPI). Pain, 23, 345–356.CrossRefPubMedGoogle Scholar
  30. Kothari, D. J., Davis, M. C., Yeung, E. W., & Tennen, H. A. (2015). Positive affect and pain: Mediators of the within-day relation linking sleep quality to activity interference in fibromyalgia. Pain, 156, 540–546. doi: 10.1097/01.j.pain.0000460324.18138.0a CrossRefPubMedGoogle Scholar
  31. Lawrence, R. C., Felson, D. T., Helmick, C. G., Arnold, L. M., Choi, H., Deyo, R. A., & Hunder, G. G. (2008). Estimates of the prevalence of arthritis and other rheumatic conditions in the United States: Part II. Arthritis and Rheumatism, 58, 26–35.PubMedCentralCrossRefPubMedGoogle Scholar
  32. Leonard, M. T., Cano, A., & Johansen, A. B. (2006). Chronic pain in a couples context: A review and integration of theoretical models and empirical evidence. Journal of Pain, 7, 377–390.PubMedCentralCrossRefPubMedGoogle Scholar
  33. Manne, S. L., & Zautra, A. J. (1990). Couples coping with chronic illness: Women with rheumatoid arthritis and their healthy husbands. Journal of Behavioral Medicine, 13, 327–342.CrossRefPubMedGoogle Scholar
  34. Martire, L. M., Stephens, M., Mogle, J., Schulz, R., Brach, J., & Keefe, F. (2013). Daily spousal influence on physical activity in knee osteoarthritis. Annals of Behavioral Medicine, 45, 213–223. doi: 10.1007/s12160-012-9442-x PubMedCentralCrossRefPubMedGoogle Scholar
  35. Mason, J. H., Anderson, J. J., Meenan, R. F., Haralson, K. M., Lewis-Stevens, D., & Kaine, J. L. (1992). The rapid assessment of disease activity in rheumatology (RADAR) questionnaire. Arthritis and Rheumatism, 35, 156–162.CrossRefPubMedGoogle Scholar
  36. Morin, C. M., Gibson, D., & Wade, J. (1998). Self-reported sleep and mood disturbance in chronic pain patients. Clinical Journal of Pain, 14, 311–314.CrossRefPubMedGoogle Scholar
  37. Murphy, L., Schwartz, T. A., Helmick, C. G., Renner, J. B., Tudor, G., Koch, G., & Jordan, J. M. (2008). Lifetime risk of symptomatic knee osteoarthritis. Arthritis Care & Research, 59, 1207–1213.CrossRefGoogle Scholar
  38. Naughton, F., Ashworth, P., & Skevington, S. M. (2007). Does sleep quality predict pain-related disability in chronic pain patients? The mediating roles of depression and pain severity. Pain, 127, 243–252.CrossRefPubMedGoogle Scholar
  39. Newth, S., & Delongis, A. (2004). Individual differences, mood, and coping with chronic pain in Rheumatoid Arthritis: A daily process analysis. Psychology and Health, 19, 283–305.CrossRefGoogle Scholar
  40. Newton-John, T., & Williams, A. (2006). Chronic pain couples: Perceived marital interactions and pain behaviours. Pain, 123, 53–63.CrossRefPubMedGoogle Scholar
  41. O’Brien, E. M., Waxenberg, L. B., Atchison, J. W., Gremillion, H. A., Staud, R. M., McCrae, C. S., & Robinson, M. E. (2011). Intraindividual variability in daily sleep and pain ratings among chronic pain patients: Bidirectional association and the role of negative mood. Clinical Journal of Pain, 27, 425–433. doi: 10.1097/AJP.0b013e318208c8e4 CrossRefPubMedGoogle Scholar
  42. Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models: Applications and data analysis methods (Vol. 1). Beverly Hills: Sage.Google Scholar
  43. Romano, J. M., Turner, J. A., Jensen, M. P., Friedman, L. S., Bulcroft, R. A., Hops, H., & Wright, S. F. (1995). Chronic pain patient-spouse behavioral interactions predict patient disability. Pain, 63, 353–360.CrossRefPubMedGoogle Scholar
  44. Schuster, T. L., Kessler, R. C., & Aseltine, R. H, Jr. (1990). Supportive interactions, negative interactions, and depressed mood. American Journal of Community Psychology, 18, 423–438.CrossRefPubMedGoogle Scholar
  45. Smith, M. T., & Haythornthwaite, J. A. (2004). How do sleep disturbance and chronic pain inter-relate? Insights from the longitudinal and cognitive-behavioral clinical trials literature. Sleep Medicine Reviews, 8, 119–132.CrossRefPubMedGoogle Scholar
  46. Smith, M. T., Perlis, M. L., Smith, M. S., Giles, D. E., & Carmody, T. P. (2000). Sleep quality and presleep arousal in chronic pain. Journal of Behavioral Medicine, 23, 1–13.CrossRefPubMedGoogle Scholar
  47. Spanier, G. B. (1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15–28.CrossRefGoogle Scholar
  48. Stephens, M. A. P., Martire, L. M., Cremeans-Smith, J. K., Druley, J. A., & Wojno, W. C. (2006). Older women with osteoarthritis and their caregiving husbands: Effects of pain and pain expression on husbands’ well-being and support. Rehabilitation Psychology, 51, 3–12.CrossRefGoogle Scholar
  49. Thomas, D. L., & Diener, E. (1990). Memory accuracy in the recall of emotions. Journal of Personality and Social Psychology, 59, 291–297.CrossRefGoogle Scholar
  50. Totterdell, P., Reynolds, S., Parkinson, B., & Briner, R. B. (1994). Associations of sleep with everyday mood, minor symptoms, and social-interaction experience. Sleep, 17, 466–475.PubMedGoogle Scholar
  51. Turk, D. C., Kerns, R. D., & Rosenberg, R. (1992). Effects of marital interaction on chronic pain and disability: Examining the down side of social support. Rehabilitation Psychology, 37, 259–274.CrossRefGoogle Scholar
  52. van der Helm, E., Gujar, N., & Walker, M. P. (2010). Sleep deprivation impairs the accurate recognition of human emotions. Sleep, 33, 335–342.PubMedCentralPubMedGoogle Scholar
  53. Waters, W. F., Adams, S. G., Binks, P., & Varnado, P. (1993). Attention, stress and negative emotion in persistent sleep-onset and sleep maintenance insomnia. Sleep, 16, 128–136.PubMedGoogle Scholar
  54. Zautra, A. J., Johnson, L. M., & Davis, M. C. (2005). Positive affect as a source of resilience for women in chronic pain. Journal of Consulting and Clinical Psychology, 73, 212–220.PubMedCentralCrossRefPubMedGoogle Scholar
  55. Zautra, A. J., Smith, B., Affleck, G., & Tennen, H. (2001). Examinations of chronic pain and affect relationships: Applications of a dynamic model of affect. Journal of Consulting and Clinical Psychology, 69, 786–795.CrossRefPubMedGoogle Scholar
  56. Zawadzki, M. J., Graham, J. E., & Gerin, W. (2013). Rumination and anxiety mediate the effect of loneliness on depressed mood and sleep quality in college students. Health Psychology, 32, 212–222.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Sunmi Song
    • 1
    Email author
  • Jennifer E. Graham-Engeland
    • 2
  • Jacqueline Mogle
    • 3
  • Lynn M. Martire
    • 4
  1. 1.Social and Behavioral Research Branch, National Human Genome Research InstituteNational Institutes of HealthBethesdaUSA
  2. 2.Department of Biobehavioral HealthThe Pennsylvania State UniversityUniversity ParkUSA
  3. 3.The College of NursingThe Pennsylvania State UniversityUniversity ParkUSA
  4. 4.Department of Human Development and Family StudiesThe Pennsylvania State UniversityUniversity ParkUSA

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