Mental Health Care Needs of Racial and Ethnic Minorities Living with Chronic Pain: A Scoping Review

Context Pain is defined as “an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage” (Raja et al., 2020). Notes accompanying this definition further emphasize that pain is a subjective experience influenced by biological, psychological, and social factors (Raja et al., 2020). As a social factor influencing the experience of pain, disparities in the assessment and treatment of pain among racial and ethnic minorities have been extensively documented for all types of pain (including chronic pain) across healthcare settings (e.g., acute care, primary care; Anderson et al., 2009; Campbell & Edwards, 2012; Green et al., 2003; Hoffman et al., 2016; Lee et al., 2019; Morales & Yong, 2021; Mossey, 2011; Roseen et al., 2022; Stanaway & Campbell, 2022). These disparities in pain assessment and treatment are also likely to extend to mental health care for pain. Mental health care for racial and ethnic minorities living with chronic pain is essential as pain often brings with it an increased risk for psychological distress. Therefore, an understanding of the mental health needs of racial and ethnic minorities living with chronic pain is warranted. Limited research exists on the mental health needs of this population, and this research is even more sparse within the Canadian context. Objectives Thus, the proposed project is aimed at addressing the following research questions: 1. How do ethnic and racial minorities living with chronic pain and associated psychological distress describe their experiences accessing and utilizing mental health care services? It is hypothesized that individuals from ethnic and racial minorities living with chronic pain and associated psychological distress have had challenges in accessing and utilizing mental health care services and that they have also shown resilience in finding ways of managing their psychological distress through mental health care services or other means (e.g., community supports). 2. What mental health care services would meet the needs of ethnic and racial minorities living with chronic pain and associated psychological distress? It is hypothesized that individuals from ethnic and racial minorities living with chronic pain and associated psychological distress will share several ideas regarding the type of mental health care services that would meet their needs and that these ideas will differ across and within ethnic and racial minority groups. Methodology The proposed study will be comprised of three components: 1. Community Engagement: Throughout the phases of the proposed study, our research team will consult with individuals belonging to racial or ethnic minority groups with lived experiences of chronic pain. We will hold meetings with these community members in which they are encouraged to share their lived experiences while the research team listens and integrates these insights into the work being conducted. The research team has appropriate experience in community-engaged research in Saskatchewan and across Canada. 2. Scoping Review: The first phase of the proposed study will involve a scoping review of the current literature to understand and map out the currently documented racial and ethnic disparities in accessing and utilizing mental health care while living with chronic pain. This scoping review will guide the design and implementation of a sequential mixed methods explanatory study as described below. More specifically, it will allow the research team to identify the most appropriate self-report questionnaires and interview questions for our mixed methods study. 3. Sequential Mixed Methods Explanatory Study: For this mixed methods study, participants will include individuals belonging to racial or ethnic minority groups who are at least 18 years of age, live in Canada, and are living with chronic pain and associated psychological distress. Recruitment will involve partnerships with community organizations that serve individuals living with chronic pain so that these community organizations can distribute information about the study through their mailing lists, newsletters, bulletin boards, or social media posts. The quantitative phase of the study will involve the distribution of a set of self-report questionnaires to racial and ethnic minorities across Canada. While the specific self-report questionnaires will be identified as part of the scoping review, we expect that our set of questionnaires will include questions regarding participants’ experience of chronic pain, access and utilization of mental health care services currently available, and their needs with respect to culturally appropriate mental health care services. Data analysis will include, as appropriate, descriptive and inferential statistics. For the qualitative phase of the study, a subsample of participants from the quantitative study will be invited to participate in a follow-up individual interview to further expand on the abovementioned topics. Reflexive thematic analysis will be employed in the analysis of narrative responses.

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