Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden

Incidence of sick leave and disability pension in adults with musculoskeletal pain and co-occurring long-term conditions: data from the Norwegian HUNT study and national registries

BACKGROUND

Musculoskeletal pain is one of the leading causes of work productivity loss. Long-term conditions (LTCs) commonly occur alongside musculoskeletal pain. However, the incidence of sick leave and disability pension according to LTC status in people with musculoskeletal pain has not been previously described.

METHODS

Working-age participants (20-65 years) with persistent musculoskeletal pain who participated in the HUNT3 Study (1995-97) were included. Twenty-five LTCs were classified into 8 LTC groups according to the International Classification of Diseases version 11. Data on sickness and disability benefits were obtained from the National Insurance Database and linked to the HUNT3 data using participants' personal identification number. Age-adjusted incidence rates (IRs) (per 10,000 person-years) and hazard ratios (HRs) of sick leave during 5-year follow-up and disability pension during ~ 25-year follow-up were estimated with 95% confidence intervals (CIs) and presented according to LTC status.

RESULTS

Overall, 11,080 participants with musculoskeletal pain were included. Of those, 32% reported one LTC and 45% reported ≥ 2 LTCs. During the follow up period, 1,312 participants (12%) received disability pension due to musculoskeletal conditions. The IR of sick leave and disability pension due to musculoskeletal conditions increased with number of LTCs. Specifically, the IR of sick leave was 720 (95% CI 672 to 768) in participants without any LTCs and 968 (95% CI 927 to 1,009) if they had ≥ 2 LTCs. The IRs of disability pension were 87 (95% CI 75 to 98) and 167 (95% CI 154 to 179) among those with no LTCs and ≥ 2 LTCs, respectively. The incidence of sick leave and disability pension due to musculoskeletal conditions was largely similar across LTCs, although the incidence of disability pension was somewhat higher among people with sleep disorders (IR: 223, 95% CI 194 to 252).

CONCLUSIONS

Among people with persistent musculoskeletal pain, the incidence of prematurely leaving the work force due to musculoskeletal conditions was twice as high for those with multiple LTCs compared to those without any LTCs. This was largely irrespective of the type of LTC, indicating that the number of LTCs are an important feature when evaluating work participation among people with musculoskeletal pain.

Risk factors for common mental disorders in young refugees from Iran, Somalia and Syria to Sweden

BACKGROUND

Our primary aim was to determine sociodemographic and health-related risk factors for diagnosed common mental disorders (CMDs) among young refugees in Sweden.

METHODS

All young adult refugees from Iran, Somalia and Syria (n = 7192), who were residents in Sweden in 2009, were followed from 2010 to 2013 regarding diagnosed CMDs. Cox regression models were used to compute hazard ratios (HRs) of CMDs with 95% confidence intervals (CIs).

RESULTS

Those arriving as unaccompanied refugee minors had a lower risk of being diagnosed with CMDs (HR: 0.7; 95%CI: 0.6-0.9) than those arriving as accompanied refugee minors. A higher risk of being diagnosed with CMDs was also found in female refugees (HR: 1.3; 95%CI: 1.1-1.5) compared with male refugees. In addition, individuals with a low (HR: 1.7; 95%CI: 1.3-2.3) or a medium (HR: 1.4; 95%CI: 1.1-1.8) educational level were found to have a higher risk of being diagnosed with CMDs compared with individuals with a high educational level. Refugees from Iran (HR: 2.3; 95%CI: 1.8-2.9) had a higher risk of a diagnosis of a CMD than refugees from Somalia. Moreover, refugees with a diagnosis of a mental disorder other than a CMD (HR: 4.2; 95%CI: 2.8-6.1), digestive (HR: 1.5; 95%CI: 1.0-2.2) or musculoskeletal diseases (HR: 1.5; 95%CI: 1.0-2.2) had a higher risk of being diagnosed with subsequent CMDs, compared with those with no such disorders.

CONCLUSIONS

Pre-existing diagnoses of mental disorders other than CMDs, and digestive and musculoskeletal disorders should be carefully considered in clinical assessments to initiate early interventions to prevent CMDs.

Association of common mental disorders and related multimorbidity with subsequent labor market marginalization among refugee and Swedish-born young adults

Background

Common mental disorders (CMDs), multimorbidity, and refugee status are associated with poor labor market outcome. Little is known about how these factors interact in young adults.

Objective

We aimed to i) investigate whether the association of CMDs and multimorbidity with labor market marginalization (LMM) differs between refugee and Swedish-born young adults and ii) identify diagnostic groups with particularly high risk for LMM.

Methods

This longitudinal registry-based study included individuals aged 20–25 years followed from 2012 to 2016 in Sweden (41,516 refugees and 207,729 age and sex-matched Swedish-born individuals). LMM was defined as granted disability pension (DP) or > 180 days of unemployment (UE). A disease co-occurrence network was constructed for all diagnostic groups from 2009 to 2011 to derive a personalized multimorbidity score for LMM. Multivariate logistic regression was used to estimate odds ratios of LMM in refugee and Swedish-born youth as a function of their multimorbidity score. The relative risk (RR, 95% CI) of LMM for refugees with CMDs compared to Swedish-born with CMDs was computed in each diagnostic group.

Results

In total, 5.5% of refugees and 7.2% of Swedish-born with CMDs were granted DP; 22.2 and 9.4%, respectively received UE benefit during follow-up. While both CMDs and multimorbidity independently elevated the risk of DP considerably in Swedish-born, CMDs but not multimorbidity elevated the risk of UE. Regarding UE in refugees, multimorbidity with the presence of CMDs showed stronger estimates. Multimorbidity interacted with refugee status toward UE (p < 0.0001) and with CMDs toward DP (p = 0.0049). Two diagnostic groups that demonstrated particularly high RR of UE were schizophrenia, schizotypal and delusional disorders (RR [95% CI]: 3.46 [1.77, 6.75]), and behavioral syndromes (RR [95% CI]: 3.41 [1.90, 6.10]).

Conclusion

To combat LMM, public health measures and intervention strategies need to be tailored to young adults based on their CMDs, multimorbidity, and refugee status.

Usability Study of the iACTwithPain Platform: An Online Acceptance and Commitment Therapy and Compassion-Based Intervention for Chronic Pain

Background

This pilot study aims to test the usability of the iACTwithPain platform, an online ACT-based intervention for people with chronic pain, to obtain information on which intervention and usability aspects need improvement and on expected retention rates.

Methods

Seventy-three Portuguese women with chronic pain were invited to complete the first three sessions of the iACTwithPain intervention assess their quality, usefulness and the platform’s usability. Twenty-one accepted the invitation. Additionally, eight healthcare professionals working with chronic medical conditions assessed the platform and the intervention from a practitioner’s point of view.

Results

This study presented a considerable attrition rate (71.43%) among chronic pain participants, with six completers. There were no significant differences in demographic or clinical variables between dropouts and completers except for completed education (participants who dropped out presented less education than completers). Reasons for dropout were related to difficult personal events occurring during the time of the intervention, lack of time, or having forgotten. There seemed to be an overall satisfaction with both the intervention, its contents and form of presentation of information, and the platform, concerning its design, appearance, and usability. Real image videos were preferred over animations or audio by chronic pain participants. Healthcare professionals emphasized the appealing and dynamic aspects of the animation format.

Conclusion

This study informs the ongoing improvement of the iACTwithPain platform and provides valuable information on aspects researchers should consider while developing online psychological interventions for chronic pain. Further implications are discussed.

Tapping the Potential of Resilience to Support an Integrated and Person-Centred Approach to Health and Wellbeing-Developing a Simple Assessment Tool for Practice

(1) Background: The push towards population health management and the need for new approaches in health services delivery focusing on the prevention and management of chronic diseases has helped in advocating for more person-centred care, and thus for integration of physical and mental health. Resilience plays a key role in supporting sustainable lifestyle changes and promoting health and wellbeing, but most assessment tools available today are too long for widespread use. The purpose of this paper is to describe the development of a new diagnostic tool to capture a person's resilience and resources. (2) Methods: This paper outlines the interrelatedness of different theories of salutogenesis, social determinants of health and health promotion with resilience and establishes resilience as a key enabler to promote health and wellbeing. (3) Results: A new, short questionnaire is proposed based on the triade of evidence-based medicine, which should be easy to use and give a good assessment of a person's resilience. (4) Conclusions: There are many reasons why the call for a short and easy-to-use assessment tool for resilience is warranted. In view of the international transition towards integrated, person-centred health systems, such a tool would find many usages. It would also support the strategies to tackle multi-morbidity, complex conditions and the social determinants of health in its focus on strengthening an individual's ability to cope with adverse events, and actively engage in health promotion and community involvement programmes. The next step is to test the tool in practice and validate it.

Joint effects of back pain and mental health conditions on health care utilization and costs in Ontario, Canada: A population-based cohort study

ABSTRACT

We assessed the joint effects of back pain and mental health conditions on healthcare utilization and costs in a population-based sample of Ontario adults. We included Ontario adult respondents of Canadian Community Health Survey between 2003-2012, followed to 2018 by linking survey data to administrative databases. Joint exposures were self-reported back pain and mental health conditions (fair/poor mental health, mood, anxiety disorder). We built negative binomial, modified Poisson, and linear (log-transformed) models to assess joint effects (effects of two exposures in combination) of comorbid back pain and mental health condition on healthcare utilization, opioid prescription, and costs, adjusting for sociodemographic, health-related and behavioural factors. We evaluated positive additive and multiplicative interaction (synergism) between back pain and mental health conditions with relative-excess risk due-to-interaction (RERI) and ratio of rate-ratios (RR). The cohort (n=147,486) had a mean age of 46 years (SD=17), and 51% were female. We found positive additive and multiplicative interaction between back pain and fair/poor mental health (RERI=0.40;RR=1.12) and mood disorder (RERI=0.41;RR=1.04), but not anxiety for back pain-specific utilization. For opioid prescription, we found positive additive and multiplicative interaction between back pain and fair/poor mental health (RERI=2.71;RR=3.20) and anxiety (RERI=1.60;RR=1.80), and positive additive interaction with mood disorder (RERI=0.74). There was no evidence of synergism for all-cause utilization or costs. Combined effects of back pain and mental health conditions on back pain-specific utilization or opioid prescription were greater than expected, with evidence of synergism. Health services targeting back pain and mental health conditions together may provide greater improvements in outcomes.

Diagnosis-Specific Work Disability before and after Lumbar Spine Decompression Surgery-A Register Study from Sweden

Low back pain (LBP) patients undergoing lumbar spine decompression surgery (LSDS) often suffer from multi-comorbidity and experience high work disability. This study aimed to identify diagnosis-specific work disability patterns in all LBP-patients before and after LSDS during 2008–2010, that were aged 19–60 years and living in Sweden (n = 10,800) and compare these patterns to LBP-patients without LSDS (n = 109,179), and to matched individuals without LBP (n = 472,191). Work disability days (long-term sickness absence (LTSA), disability pension (DP)) during the three years before to three years after the cohort’s entry date were identified by generalised estimating equations. LBP-patients undergoing LSDS had higher overall work disability during the three years following surgery (LTSA: 23.6%, DP: 6.3%) than LBP-patients without LSDS (LTSA: 19.5%, DP: 5.9%), and those without LBP (LTSA: 7.9%, DP: 1.7%). Among patients undergoing LSDS, the prevalence of work disability due to dorsopathies increased from 20 days three years before surgery to 70 days in the year after and attenuated to 30 days in the third year following surgery. Work disability for other diagnoses remained stable at a low level in this group (<10 days annually). LBP-patients undergoing LSDS have an unfavourable long-term work disability prognosis, primarily due to dorsopathies. Decompression surgery seemed to restrict further inclines in work disability in the long run.

Study protocol for a randomized controlled trial to improve the quality of life of housewives with musculoskeletal disorders: a health promotion intervention based on a participatory ergonomic approach-the Housewives Ergonomic Intervention (HEI) trial

Background

A variety of household chores expose women to a variety of biomechanical and psychosocial risk factors. A result of this is many housewives with musculoskeletal disorders. Given the interactive effects of these risk factors, it is necessary to consider multiple strategies to mitigate their effects. Accordingly, the present study will investigate the impact of a health promotion training program based on a participatory ergonomic approach towards a reduction in the prevalence of musculoskeletal disorders and an improvement in the quality of life of housewives.

Methods

Iranian housewives aged 20–65 years currently attending a specialist health clinic due to a painful musculoskeletal complaint will be invited to join the study. Recruitment will continue until a sample of 160 women provides informed consent to participate. The study will be conducted using a mixed-methods protocol in two phases. In the first phase, psychosocial and biomechanical risk factors will be identified using a qualitative approach. In the next phase, the results from the qualitative approach will be used to develop a conceptual framework based on health promotion theories and an intervention program based on a participatory ergonomic approach designed. Participants will be randomly allocated into one of four groups: (1) biomechanical intervention group, (2) psychosocial intervention group, (3) multidisciplinary intervention group (both biomechanical and psychosocial intervention), and (4) a control group. Data will be collected using Rapid Entire Body Assessment (REBA), Visual Analog Scale (VAS), Work Ability Score (WAS), Hospital Anxiety and Depression Scale (HADS), and the 36-item Short-Form health survey (SF-36) at baseline in 3-month and 6-month follow-up assessments. The impact of the three interventions on musculoskeletal disorders, work ability, stress, and quality of life will then be evaluated.

Discussion

The study will provide a practical approach to reducing stress, reducing musculoskeletal disorders, enhancing the ability to work, and improving the quality of life of women with musculoskeletal disorders associated with housework. If the designed interventions in the present study are effective, they will have the great practical potential for generalization to all housewives.

Trial registration

ClinicalTrials.gov IRCT20200602047640N. Registered on 07 September 2020 with the IRCTID.

Shared liability to pain, common mental disorders, and long-term work disability differs among women and men

Knowledge of factors involved in the associations between pain, common mental disorders, and future work incapacity is still scarce. The aim of this study was to examine the overlap between genetic and environmental factors contributing to depression/anxiety, pain, and future long-term sickness absence (SA) and disability pension (DP) among women and men. The study sample included 47,995 twins born in Sweden 1935 to 1985. Information on self-reported depression/anxiety and back, neck, and shoulder pain was obtained from surveys conducted 1998 to 2002 and 2004 to 2005. Data on long-term SA (>365 days) and DP due to mental and/or musculoskeletal disorders until 2013 were obtained from the National Social Insurance Agency. Shared genetic and environmental influences on depression/anxiety, pain, and SA/DP were estimated by applying structural equation modeling. The prevalence of depression/anxiety was 27% and 14% among women and men, for pain 24% and 19%, and for SA/DP due to mental and musculoskeletal diagnoses 7% and 4%, respectively. Multivariate biometric analyses revealed different patterns of covariation between the 3 phenotypes among women and men. For women, a latent-shared liability to all 3 phenotypes could be identified, mainly attributable to genetic factors (66%). For men, no shared underlying liability was observed. The variation in SA/DP was explained by genetic factors in common with depression/anxiety by 27% and in common with pain by 9%. Common mental disorders, pain, and SA/DP tend to covariate in different ways among women and men. The results may have clinical implications as strategies preventing SA/DP may be different among women and men.

Who Suffers From Pharmaceutical Poverty and What Are Their Needs? Evidence From a Spanish Region

Background: Pharmaceutical poverty occurs when a patient cannot afford the cost of prescribed medication and/or medical products. Nonprofit organizations are covering the cost of medication to those patients in some contexts. The aim of the study was to describe the population of beneficiaries of the PB, a nongovernmental organization based on the primary healthcare system, which provides free-of-charge access to medicines and their utilization pattern of medicines and healthcare products. Methods: This was an observational study using PB beneficiary data collected between November 2017 and December 2018 in Catalonia. The Catalan Health Service provided information from the general population. A descriptive analysis of the beneficiaries' characteristics was conducted and compared to the general population. Results: The beneficiaries (N = 1,206) were mainly adults with a low level of education, unemployed, with functional disability, and with ≥1 child. Compared with the general population, the beneficiaries were older, had a lower level of education, showed a higher prevalence of functional disability, were less likely to be Spanish, and were more likely to be divorced and unemployed. The beneficiaries were polymedicated, and most were using medication related to the nervous (79%), musculoskeletal (68%), and cardiovascular system (56%) and alimentary tract and metabolism (68%). Almost 19% of beneficiaries used healthcare products. Female beneficiaries were older and more likely to be divorced or widowed, employed, and with children. Compared to men, women were more likely to use medicines for pain and mental disorders. The pediatric group used medications for severe, chronic conditions (heart diseases, autoimmune diseases, conduct disorders, and attention deficit hyperactivity disorder). Conclusion: Patients with severe, chronic, and disabling conditions are affected by pharmaceutical poverty. While the system of copayment remains unchanged, family physicians and pediatricians should explore economic barriers to treatment and direct their patients to resources that help to cover the cost of treatment.

Disability pension and mortality in individuals with specific somatic and mental disorders: examining differences between refugees and Swedish-born individuals

Background

More than half a million refugees have arrived to Sweden during the last decade. The aim was to investigate differences between refugees and Swedish-born individuals regarding different specific somatic and mental disorders, and subsequent disability pension and mortality.

Methods

All refugees (n=239 742) and Swedish-born individuals (n=4 133 898), aged 19–60 years, resident in Sweden on 31st of December in 2009 were included in this population-based prospective cohort study. Data from six nationwide Swedish registers were linked by the unique anonymised identification number. HRs with 95% CIs were computed for disability pension and mortality 2010–2013 by Cox regression models.

Results

Compared with their Swedish-born counterparts with mental or somatic diagnoses, refugees with these diagnoses had a higher risk of subsequent disability pension and a lower risk of mortality. Highest estimates for disability pension were seen for refugees with neoplasm (HR: 1.72; 95% CI: 1.56 to 1.91), musculoskeletal disorders (HR: 1.57; 95% CI: 1.47 to 1.67), diseases of the circulatory system (HR: 1.33; 95% CI: 1.22 to 1.45), depressive disorders (HR: 1.31; 95% CI: 1.21 to 1.41) and diabetes mellitus (HR: 1.30; 95% CI: 1.15 to 1.47). The risk of mortality was lowest for refugees with regard to bipolar disorders (HR: 0.37; 95% CI: 0.16 to 0.82), post-traumatic stress disorder (HR: 0.37; 95% CI: 0.25 to 0.54) and least pronounced in regard to neoplasm (HR: 0.69; 95% CI: 0.61 to 0.77) compared with Swedish-born with similar disorders.

Conclusion

Refugees have a generally higher risk of disability pension compared with Swedish-born with specific somatic and mental disorders. Despite this, refugees with all specific disorders have lower risk estimates of mortality, probably due to a healthy selection. The higher risk of disability pension might therefore be due to other causes besides poor health.

Predictors of working days lost due to sickness absence and disability pension

Objective

To identify social and health-related predictors of the number of days lost due to sickness absence (SA) and disability pension (DP) among initially 55-year-old public-sector workers.

Methods

The data from the Finnish Helsinki Health Study included participants aged 55 years at the baseline (in 2000–2002, N = 1630, 81% women), and were enriched with register-based information on SA and DP. The cumulative number of calendar days lost due to SA ≥ 1 day or DP between ages 55 and 65 was calculated. Negative binomial regression model was used to identify the predictors of days lost.

Results

The average calendar days lost was 316 days (about 220 working days) during a 10-year follow-up, and 44% were due to SA and 56% due to DP. Smoking [incidence rate ratio (IRR) = 1.19, 95% CI 1.01–1.40 for past and IRR = 1.30, CI 1.07–1.58 for current], binge drinking (IRR = 1.22, CI 1.02–1.46), lifting or pulling/pushing heavy loads (IRR = 1.35, CI 1.10–1.65), awkward working positions (IRR = 1.24, CI 1.01–1.53), long-standing illness limiting work or daily activities (IRR = 2.32, CI 1.93–2.79), common mental disorder (IRR = 1.52, CI 1.30–1.79), and multisite pain (IRR = 1.50, CI 1.23–1.84) increased the number of days lost, while high level of education (IRR = 0.66, CI 0.52–0.82) and moderate level of leisure-time physical activity (IRR = 0.80, CI 0.67–0.94) reduced the number of days lost.

Conclusions

Modifiable lifestyle risk factors, workload factors, common mental disorder, and multisite pain substantially increase the number of days lost. However, the findings of this study could be generalized to female workers in the public sector. Future research should also consider shorter SA spells in estimating working years lost and working life expectancy.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00420-020-01630-6.

Number of Pain Locations as a Predictor of Cause-Specific Disability Pension in Sweden-Do Common Mental Disorders Play a Role?

OBJECTIVE

The aim of this study was to investigate the associations between number of pain locations, common mental disorders (CMDs), and disability pension (DP).

METHODS

Survey data in 1998 to 2003 for 27,165 Swedish twins born in 1935 to 1958 were linked to national DP data until 2013. Pain locations were evaluated for back, low back, sciatica, shoulder, or neck pain, and CMDs for lifetime major depression and 1-month anxiety.

RESULTS

The number of pain locations was associated with DP in a dose-response manner. One pain location had a hazard ratio of 1.50 (95% confidence interval 1.35 to 1.68) and five pain locations hazard ratio 4.67 (95% confidence interval 4.11 to 5.30) for DP. Also, CMDs were associated with DP.

CONCLUSION

The number of pain locations has a dose-response association with the risk of DP. CMDs predict DP. In strategies to prevent DP, early signs of pain or CMDs should be taken into consideration.

The Early Burden of Disability in Individuals With Mood and Other Common Mental Disorders in Ontario, Canada

IMPORTANCE

Large population-based data on the trajectory to disability after the first diagnosis of a mood disorder are lacking.

OBJECTIVE

To assess the time between an incident mood disorder diagnosis and the receipt of disability services during a follow-up period of as long as 20 years.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used health administrative and social service data from ICES for 1 902 792 adults aged 18 to 59 years living in Ontario, Canada. A narrow cohort of individuals who had a new diagnosis of a mood disorder between October 1, 1997, and March 31, 2007, matched by sex and age to individuals with no history of mood disorder, included 278 296 participants. A broader cohort of individuals who had a new diagnosis of other common mental disorders during the same period, matched by sex and age to individuals with no history of mental disorder diagnosis, included 1 624 496 individuals. All individuals were followed up to a maximum end date of March 31, 2017. Data analysis was conducted from November 2017 to June 2018.

EXPOSURE

Incident diagnosis of mood or common mental disorder.

MAIN OUTCOMES AND MEASURES

Disability outcomes were as follows: (1) entry into the Ontario Disability Support Program (ODSP), signifying long-term inability to work because of a disability, and (2) admission into a long-term care (LTC) residence, signifying the inability to live in independent housing. Cox proportional hazards models were used.

RESULTS

In the full cohort of 1 902 792 individuals, 278 296 participants (14.6%) were included in the mood disorder cohort (mean [SD] age, 37.5 [11.9] years; 157 386 [56.6%] women), and 1 624 496 participants (85.4%) were included in the common mental disorder cohort (mean [SD], 36.5 [11.8] years; 932 545 [57.4%] women). The incidence of ODSP initiation was greater among individuals with mood disorders than those without (51.5 per 10 000 person-years vs 25.5 per 10 000 person-years; adjusted hazard ratio [aHR], 2.03; 95% CI, 1.95-2.11) and for those with common mental disorders (45.0 per 10 000 person-years vs 27.6 per 10 000 person-years; aHR, 1.57; 95% CI, 1.55-1.60). The aHR for admission to LTC was also higher among individuals with mood disorders compared with those without (aHR, 2.20; 95% CI, 1.80-2.69) and those with common mental disorders compared with those without (aHR, 1.21; 95% CI, 1.14-1.29). Individuals with bipolar disorders had greater ODSP rates than individuals with major depressive disorders (crude rate ratio: 4.31 [95% CI, 3.56-5.17] vs 1.82 [95% CI, 1.36-2.43]).

CONCLUSIONS AND RELEVANCE

This cohort study found that mood disorders were associated with elevated and early rates of disability services. Effective early intervention strategies targeting functional impairment in this population are encouraged.

Sick leave due to back pain, common mental disorders and disability pension: Common genetic liability

BACKGROUND

Back pain and common mental disorders are often comorbid and known risk factors for future disability pension. However, the reason for the covariation is not known. The aim was to investigate the common genetic and environmental influences on the covariation between sick leave due to back pain, sick leave due to common mental disorders and disability pension.

METHODS

Register data from the Swedish Social Insurance Agency on sick leave due to back pain, common mental disorders and disability pension between 2005 and 2018, in a population-based sample of 56,686 working age twins was used to construct biometric twin models to calculate if the covariation between the traits were due to Additive (A) or Dominant (D) genetic factors, Common environmental factors (C) or unique Environmental factors (E), for women and men.

RESULTS

The phenotypic correlations ranged between 0.17 and 0.25. A common factor common pathway AE model fitted best for both women and men. The latent underlying common factor, that explained the covariation was mostly explained by genetic factors (87% for women and 90% for men). Each trait was also influenced by its own unique genetic and unique environment factors. A higher heritability was found for disability pension than for sick leave.

CONCLUSIONS

The covariation between sick leave due to back pain and common mental disorders, and disability pension were mostly explained by common genetic factors, while the unique variation in each trait was influenced by both genetic and environmental factors not shared within the twin pairs.

SIGNIFICANCE

A common genetic liability seems to be of importance in the comorbidity of sick leave due to back pain and common mental disorders and the transition to disability pension, both among women and men. However, the proportion in each trait that was explained by genetic factors was somewhat higher for men than for women in all traits. This may be of importance to consider in intervention or prevention efforts.

[Antiresorptive-cytokine effects of the chondroprotective therapy in patients with lower back pain]

OBJECTIVE

To evaluate the antiresorptive-cytokine effects of chondroitin sulfate on non-specific lower back pain in patients with knee osteoarthritis (OA).

MATERIALS AND METHODS

Using the envelope method, 231 patients were randomized into two groups: group 1 (n=116, main) received nonsteroidal anti-inflammatory drugs (NSAIDs) and chondrogard, group 2 (n=115, comparison) received only NSAIDs. The 2-month study included 3 visits (V): V₁ - at the beginning of the study, V₂ - after 10 days, V₃ - after 60 days with the assessment of blood parameters: transforming growth factor β1 (TFR β1), interleukin (IL)-1β and IL-6, beta-Crosslaps, bone matrix formation indicator P1NP (n-terminal propeptide procollagen type 1), and determination of the level of deoxypyridinoline (DPID) in the urine.

RESULTS AND CONCLUSION

At the end of the study, there is a significant decrease in all studied cytokines in patients of group 1 compared to group 2, as well as indicators of beta-Crosslaps (p<0,001) and DPID (p<0,001), which may indicate the presence of its own antiresorptive-cytokine effect in chondroitin sulfate.

Trajectories of sickness absence and disability pension before and after opioid initiation for noncancer pain: a 10-year population-based study

Chronic noncancer pain is a leading cause of sickness absence (SA) and disability pension (DP). The objectives of this study were to identify trajectories of SA/DP before and after strong and weak opioid initiation for noncancer pain and the factors associated with these trajectories. A longitudinal population-based study of 201,641 people (24-59 years) without cancer who initiated opioid analgesics in 2009 in Sweden was conducted. Trajectories of net annual SA/DP days in the 5 years before/after opioid initiation were estimated with group-based trajectory modelling. Multinomial logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with trajectory groups. Among the 6.9% of people initiating strong opioids, 12.5% had persistent high SA/DP (estimated 320 days/year) before and after opioid initiation and 72.9% had persistent low/minimum SA/DP (estimated 30 days/year). Approximately 8.6% of people had increasing SA/DP, and 6.1% had decreasing SA/DP after opioid initiation, although this seemed to reflect continuation of preinitiation patterns. Trajectories were similar at lower SA/DP days/year among those initiating weak opioids. Persistent high SA/DP among strong opioid initiators were associated with ≥5 comorbidities (OR = 8.72, 95% CI 5.61-13.56), ≤9 years of education (OR = 5.83, 95% CI 4.84-7.03), and previous use of antidepressants (OR = 4.57, 95% CI 3.89-5.37) and antipsychotics (OR = 4.49, 95% CI 2.93-6.88). Three-quarters of people initiating opioids for noncancer pain had persistent low/minimum levels of SA/DP 5 years before and after initiation. Increasing and decreasing SA/DP after opioid initiation seemed to reflect a continuation of preinitiation patterns. Our findings highlight the complex range of sociodemographic and medication-related factors associated with persistent SA/DP.

Physical working conditions and subsequent disability retirement due to any cause, mental disorders and musculoskeletal diseases: does the risk vary by common mental disorders?

PURPOSE

Physical work exposures and common mental disorders (CMD) have been linked to increased risk of work disability, but their joint associations with disability retirement due to any cause, mental disorders or musculoskeletal diseases have not been examined.

METHODS

The data for exposures and covariates were from the Finnish Helsinki Health Study occupational cohort surveys in 2000-2002, 2007 and 2012. We used 12,458 observations from 6159 employees, who were 40-60 years old at baseline. CMD were measured by the General Health Questionnaire (GHQ-12, cut-off point 3+). Four self-reported work exposures (hazardous exposures, physical workload, computer and shift work) were combined with CMD and categorized as "neither", "work exposure only", "CMD only", and "both". Associations with register-based disability retirement were assessed with Cox proportional hazards models for sample survey data adjusting for confounders over 5-year follow-up. Additionally, synergy indices were calculated for the combined effects.

RESULTS

Those reporting CMD and high physical workload had a greater risk of disability retirement due to any cause (HR 4.26, 95% CI 3.60-5.03), mental disorders (HR 5.41, 95% CI 3.87-7.56), and musculoskeletal diseases (HR 4.46, 95% CI 3.49-5.71) when compared to those with neither. Synergy indices indicated that these associations were synergistic. Similar associations were observed for CMD and hazardous exposures, but not for combined exposures to CMD and computer or shift work.

CONCLUSIONS

Identification of mental health problems among employees in physically demanding jobs is important to support work ability and reduce the risk of premature exit from work due to disability.

Health, work and demographic factors associated with a lower risk of work disability and unemployment in employees with lower back, neck and shoulder pain

Background

Chronic musculoskeletal pain affects over 20% of the adult population and is one of the most common reasons for sick leave in Sweden. The aim of this study was to investigate which demographic, health and psychosocial work environment factors are of importance for a lower risk of future work disability and unemployment among workers with low back pain (LBP) and/or neck shoulder pain (NSP), and if familial factors influence these associations.

Methods

All 5556 persons that reported having LBP and/or NSP in a web-based questionnaire study in 2004–2006 were included. They were followed up for work disability (sick leave > 90 days or disability pension), and unemployment (> 180 days in a year) until 31 December 2013. Hazard ratios (HR) with 95% confidence intervals were calculated using cox proportional hazard models of the whole sample, adjusting for covariates. In addition, co-twin analyses of outcome discordant twin pairs were conducted to assess the impact of familial confounding on the associations.

Results

Being male, 19–28 years old, having higher education, only NSP, no history of depression or anxiety, good self-rated health, low job demands and high job control were associated with a lower risk of work disability (adjusted HR ranging between 0.29–0.85). No history of anxiety and depression and high job control was associated with a lower risk of unemployment (adjusted HR ranging from 0.53 and 0.67). Familial factors were found to affect the association between education and work disability, but none of the other associations investigated.

Conclusions

Among those with LBP or NSP, good health in terms of mental- and self-rated health, few pain sites, as well as good psychosocial working conditions seem to indicate a lower risk for work disability.

Joint contribution of rotation of the back and repetitive movements to disability pension using job exposure matrix data

BACKGROUND

Heavy physical effort at work has been linked with disability pension, but the contribution of other ergonomic job exposures is less studied. We studied the independent and joint contributions of long-term exposure to (i) rotation of the back and (ii) repetitive movements to disability pension, particularly due to musculoskeletal disorders.

METHODS

Exposures were measured with the Helsinki Health Study Job Exposure Matrix during 1996-2005 and linked to register data on employees of the City of Helsinki, Finland (n = 18 585). Outcomes were followed up during 2006-2015. Competing risk survival analyses were performed and synergy indices computed, adjusting for sociodemographic factors.

RESULTS

Long-term exposure to rotation of the back was associated with disability pension due to any cause [age and sex-adjusted subhazard ratio (SHR) 2.39, 95% confidence interval (CI) 1.73-3.30], and specifically disability pension due to musculoskeletal disorders (SHR = 3.39, 95% CI 1.52-7.56) when compared to employees exposed to neither of the two exposures. Repetitive movements alone did not increase the risk of disability pension (all-cause SHR = 1.08, 95% CI 0.84-1.38, musculoskeletal SHR = 1.65, 95% CI 0.91-2.97). Employees with exposure to both rotation of the back and repetitive movements had the highest risk of disability pension due to musculoskeletal disorders (SHR = 5.98, 95% CI 3.85-9.28), but the interaction between exposures was additive rather than synergistic. Adjustment for education diluted the associations by 42-108%.

CONCLUSION

Long-term exposure to awkward work postures increased the risk of disability pension. Educational inequalities largely account for differences in occupational exposures.

Effectiveness of internet-delivered cognitive behavioural therapy in reducing sickness absence among young employees with depressive symptoms: study protocol for a large-scale pragmatic randomised controlled trial

INTRODUCTION

Depression is a highly prevalent condition with typical onset in early adulthood. Internet-delivered cognitive behavioural therapy (iCBT) is a promising cost-effective and more widely available alternative to face-to-face CBT. However, it is not known whether it can reduce sickness absence in employees showing depressive symptoms. The randomised controlled trial component of the DAQI (Depression and sickness absence in young adults: a quasi-experimental trial and web-based treatment intervention) project aims to investigate if iCBT is effective in reducing sickness absence compared with care as usual (CAU) among young employees with depressive symptoms in primary care provided in an occupational health setting.

METHODS AND ANALYSIS

This study will use a randomised controlled single-centre service-based trial of an existing iCBT programme (Mental Hub iCBT for Depression) to evaluate whether or not this treatment can reduce the number of sickness absence days in public sector employees aged 18-34 years who present at the occupational health service with mild depressive symptoms (score ≥9 on the Beck Depression Inventory-IA). Control participants will be offered CAU, with no constraints regarding the range of treatments. The active condition will consist of seven weekly modules of iCBT, with support from a web therapist. Primary outcome will be participants' all-cause sickness absence as indicated in employer's and national administrative records up to 6 months from study entry. Secondary outcomes relating to long-term sickness absence (over 11 calendar days) for mental and musculoskeletal disorders and psychotropic medication use will be obtained from the Finnish Social Insurance Institution's administrative records; and short sickness absence spells (up to 11 calendar days) will be extracted from employer's records. Analyses will be conducted on an intention-to-treat basis.

ETHICS AND DISSEMINATION

The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa has approved the study (HUS/974/2019). The results will be published in peer-reviewed scientific journals and in publications for lay audience.

TRIAL REGISTRATION NUMBER

ISRCTN10877837.

Changes in prescription of antidepressants and disability pension due to back pain, compared with other musculoskeletal and other somatic diagnoses: a cohort study in Sweden

OBJECTIVES

The aim was to investigate differences in the prescription of antidepressants during the transition to disability pension (DP) comparing DP due to back pain with DP due to other musculoskeletal and DP due to other somatic diagnoses.

DESIGN

A population-based cohort study with follow-up 3 years before and after the event. Estimated prevalence and adjusted ORs with 95% CIs for antidepressant prescription were computed for the 7-year window (ie, t-3 to t+3) around the DP by generalised estimating equations for repeated measures.

SETTING AND PARTICIPANTS

This Swedish population-based nationwide study with registry data included individuals aged 18-64 years, with DP due to back pain (n=2011), DP due to other musculoskeletal (n=3548) or DP due to other somatic diagnoses (n=11 809).

PRIMARY OUTCOME MEASURES

Prescription of antidepressants.

RESULTS

Before DP, the prevalence of prescription of antidepressants was stable in DP due to back pain, but increased for the other DP groups. Similarly, the likelihood of prescription increased only marginally before DP due to back pain (ORs from 0.86 at t-3 to 1.10 at t-1), but clearly in DP due to musculoskeletal (from 0.42 to 1.15) and somatic diagnoses (from 0.29 to 0.98). Both prevalence measures and risks remained at the elevated levels after DP.

CONCLUSIONS

Pathways to DP due to musculoskeletal and somatic diagnoses seem to be partly driven by adverse mental health, which remains at a higher level after DP. The increasing prescription of antidepressants prior to DP suggests that special attention should be paid to mental health for prevention of DP. The period after DP needs attention to avoid deterioration of mental health.

The longitudinal integrated database for health insurance and labour market studies (LISA) and its use in medical research

Education, income, and occupation are factors known to affect health and disease. In this review we describe the Swedish Longitudinal Integrated Database for Health Insurance and Labour Market Studies (LISA, Longitudinell Integrationsdatabas för Sjukförsäkrings- och Arbetsmarknadsstudier). LISA covers the adult Swedish population aged ≥ 16 years registered on December 31 each year since 1990 (since 2010 individuals aged ≥ 15 years). The database was launched in response to rising levels of sick leave in the country. Participation in Swedish government-administered registers such as LISA is compulsory, and hence selection bias is minimized. The LISA database allows researchers to identify individuals who do not work because of injury, disease, or rehabilitation. It contains data on sick leave and disability pension based on calendar year. LISA also includes information on unemployment benefits, disposable income, social welfare payments, civil status, and migration. During 2000–2017, an average of 97,000 individuals immigrated to Sweden each year. This corresponds to about 1% of the Swedish population (10 million people in 2017). Data on occupation have a completeness of 95%. Income data consist primarily of income from employment, capital, and allowances, including parental allowance. In Sweden, work force participation is around 80% (2017: overall: 79.1%; men 80.3% and women 77.9%). Education data are available in > 98% of all individuals aged 25–64 years, with an estimated accuracy for highest attained level of education of 85%. Some information on civil status, income, education, and employment before 1990 can be obtained through the Population and Housing Census data (FoB, Folk- och bostadsräkningen).

The societal costs of chronic pain and its determinants: The case of Austria

BACKGROUND

Chronic pain is among the most burdensome conditions. Its prevalence ranges between 12% and 30% in Europe, with an estimated 21% among Austrian adults. The economic impact of chronic pain from a societal perspective, however, has not been sufficiently researched. This study aims to provide an estimate of the societal costs for working-age adults with chronic pain in Austria. It explores the impact of sex, number of pain sites, self-reported pain severity, health literacy and private health insurance on costs associated with chronic pain.

METHODS

A bottom-up cost-of-illness study was conducted based on data collected from 54 adult patients with chronic pain at three Viennese hospital outpatient departments. Information on healthcare costs including out-of-pocket expenses and productivity losses due to absenteeism and informal care were collected over 12 months. Resource use estimates were combined with unit costs and mean costs per patient were calculated in € for year 2016.

RESULTS

Mean annual societal costs were estimated at EUR 10191. Direct medical costs were EUR 5725 including EUR 1799 out-of-pocket expenses (mainly pain relieving activities and private therapy). Productivity losses including informal care amounted to EUR 4466. Total costs for women and patients with three or more pain sites were significantly higher. No association with health literacy was found but there was a tendency towards higher out-of-pocket expenses for patients with complementary private health insurance.

CONCLUSION

This study is the first to provide a comprehensive assessment of the individual and societal burden of chronic pain in Austria. It highlights that chronic pain is associated with substantial direct medical costs and productivity losses. Patient costs may show systematic differences by health insurance status, implying a need for future research in this area.

Untreated depression and non-medical use of prescription pain relievers: findings from the National Survey on Drug Use and Health 2008-2014

OBJECTIVES

Despite growing concerns for non-medical use of prescription pain relievers (NMUPPRs), little is known about the role of comorbid, untreated depressive disorders.

METHODS

We examined past year rates of NMUPPRs and major depressive episode (MDE), using data between 2008 and 2014 from the National Survey on Drug Use and Health for both youths (12-17 years) and adults (18 or older). Prevalence estimates with 95% confidence intervals were computed. Stratified analyses and generalized linear models were run to examine the association between NMUPPRs and MDE, controlling for treatments received for mental health and/or substance misuse. In order to explore whether MDE effect might change by treatment received, a model with an interaction term including MDE and treatment was fit.

RESULTS

Among respondents, about 9% (youths) and 7% (adults) reported past year MDE and about 6% (youths), and 4% (adults) NMUPPRs. About 1.2% (youths) and 0.7% (adults) reported both MDE and NMUPPRs. Those with past year MDE were more likely to report NMUPPRs (RR, 95%CI: 2.60, 2.42-2.80, and 2.64, 2.47-2.82, for youths and adults). Considering the any treatment/MDE interaction on NMUPPRs, MDE risk ratio for subjects who received some treatment (youths: adjusted risk ratio (ARR) = 1.15; adults: ARR = 1.25) was about 70-80% as compared with their untreated counterpart (youths: ARR = 1.57; adults: ARR = 1.54). The likelihood of reporting NMUPPRs amongst respondents who did not receive any treatment was higher for those with past year MDE (main effect: youths ARR = 1.57, p < 0.001; adults ARR = 1.54, p < 0.001).

CONCLUSION

Unrecognized and untreated depressive disorders should be considered for prevention, treatment, and policy implications in order to tackle NMUPPRs epidemic.

Trajectories of work disability and unemployment among young adults with common mental disorders

BACKGROUND

Labour-market marginalisation (LMM) and common mental disorders (CMDs) are serious societal problems. The aims were to describe trajectories of LMM (both work disability and unemployment) among young adults with and without CMDs, and to elucidate the characteristics associated with these trajectories.

METHODS

The study was based on Swedish registers and consisted of all individuals 19-30 years with an incident diagnosis of a CMD in year 2007 (n = 7245), and a matched comparison group of individuals without mental disorders during the years 2004-07 (n = 7245). Group-based trajectory models were used to describe patterns of LMM both before, and after the incident diagnosis of a CMD. Multinomial logistic regressions investigated the associations between sociodemographic and medical covariates and the identified trajectories.

RESULTS

Twenty-six percent (n = 1859) of young adults with CMDs followed trajectories of increasing or constant high levels of work disability, and 32 % (n = 2302) followed trajectories of increasing or constant high unemployment. In the comparison group, just 9 % (n = 665) followed increasing or constant high levels of work disability and 21 % (n = 1528) followed trajectories of increasing or constant high levels of unemployment. A lower share of young adults with CMDs followed trajectories of constant low levels of work disability (n = 4546, 63%) or unemployment (n = 2745, 38%), compared to the level of constant low work disability (n = 6158, 85%) and unemployment (n = 3385, 50%) in the comparison group. Remaining trajectories were fluctuating or decreasing. Around 50% of young adults with CMDs had persistent levels of LMM at the end of follow-up. The multinomial logistic regression revealed that educational level and comorbid mental disorders discriminated trajectories of work disability, while educational level, living area and age determined differences in trajectories of unemployment (R2difference = 0.02-0.05, p < 0.001).

CONCLUSIONS

A large share, nearly 50%, of young adults with CMDs, substantially higher than in the comparison group of individuals without mental disorders, display increasing or high persistent levels of either work disability or unemployment throughout the follow-up period. Low educational level, comorbidity with other mental disorders and living in rural areas were factors that increased the probability for LMM.

Secular trends in work disability and its relationship to musculoskeletal pain and mental health: a time-trend analysis using five cross-sectional surveys (2002-2010) in the general population

OBJECTIVES

International evidence suggests that rates of inability to work because of illness can change over time. We hypothesised that one reason for this is that the link between inability to work and common illnesses, such as musculoskeletal pain and mental illness, may also change over time. We have investigated this in a study based in one UK district.

METHODS

Five population surveys (spanning 2002-2010) of working-age people aged >50 years and ≤65 years were used. Work disability was defined as a single self-reported item 'not working due to ill-health'. Presence of moderate-severe depressive symptoms was identified from the Mental Component Score of the Short Form-12, and pain from a full-body manikin. Data were analysed with multivariable logistic regression.

RESULTS

The proportion of people reporting work disability across the surveys declined, from 17.0% in 2002 to 12.1% in 2010. Those reporting work disability, one-third reported regional pain, one-half widespread pain (53%) and two-thirds moderate-severe depressive symptoms (68%). Both factors were independently associated with work disability; their co-occurrence was associated with an almost 20-fold increase in the odds of reporting work disability compared with those with neither condition.

CONCLUSIONS

The association of work disability with musculoskeletal pain was stable over time; depressive symptoms became more prominent in persons reporting work disability, but overall prevalence of work disability declined. The frequency and impact of both musculoskeletal pain and depression highlight the need to move beyond symptom-directed approaches towards a more comprehensive model of health and vocational advice for people unable to work because of illness.

Course and characteristics of work disability 3 years before and after lumbar spine decompression surgery- a national population-based study

Despite decompression surgery being a widespread intervention for patients with dorsopathies (i.e. back pain) affecting the lumbar spine, the scientific knowledge on patterns and characteristics of work disability before and after the surgery is limited. Sickness absence (SA) and disability pension (DP) were examined three years before and after surgery in 8558 patients aged 25–60 years who underwent lumbar spine decompression surgery in Sweden. They were compared to individuals with diagnosed dorsopathies but no surgery and individuals from the general population as matched comparison groups. According to Group Based Trajectory models, in patients with decompression surgery, 39% had low levels of SA/DP during the entire study period and 15% started with low levels of SA/DP, which increased in the year before, and declined to almost zero in the second year after surgery. Three trajectory groups (12%, 17%, and 18%) started at different levels of SA/DP, which increased in the years before, and declined in the third year after surgery. The trajectory groups in the comparison groups showed lower levels of work disability. Sex, education, and the use of antidepressants and analgesics the year before surgery played an important role to explain the variance of trajectory groups in patients with surgery.

Comorbidity between pain and mental illness - Evidence of a bidirectional relationship

BACKGROUND

Pain from various locations in the body and mental illness are common and the comorbidity between the two is well-known although the temporal relationship remains to be determined. Our aim was to follow patients over time to study if pain (here dorsalgia/abdominal pain) or fibromyalgia lead to an increased risk of developing mental illness (here depression/anxiety) and/or the reverse, that is whether patients with mental illness have an increased risk to develop pain or fibromyalgia, compared to the rest of the population.

METHODS

This prospective cohort study used the Skåne Healthcare Register, covering all care in the region of Skåne, southern Sweden (population ~1.3 million). The cohort included healthcare consultations in primary care, outpatient specialized care and inpatient care between 2007 and 2016 for all patients without prior registered diagnosis of mental illness or pain, aged 18 or older (n = 504,365).

RESULTS

The incidence rate ratio (IRR) for developing mental illness after pain was 2.18 (95% CI = 2.14-2.22) compared to without pain. IRR for developing pain after mental illness was 2.02 (95% CI = 1.98-2.06) compared to without mental illness. Corresponding IRR for developing mental illness after fibromyalgia was 4.05 (95% CI = 3.58-4.59) and for developing fibromyalgia after mental illness 5.54 (95% CI = 4.99-6.16).

CONCLUSIONS

This study shows a bidirectional influence of similar magnitude of pain and mental illness, respectively. In monitoring patients with pain or mental illness, a focus on both conditions is thus important to develop appropriate, targeted interventions and may increase the likelihood of improved outcomes.

SIGNIFICANCE

We followed a population-based cohort over a period of 10 years, including incident cases of both exposure and outcome and found a bidirectional relationship between pain and mental illness. Clinicians need to pay attention on both conditions, in patients seeking care due to mental illness or pain.

Sleep quality in subjects suffering from chronic pain

BACKGROUND

Sleeping problems are very common in patients with chronic pain. The aim of the study was to investigate the association between different dimensions of chronic pain and sleep quality in chronic pain patients.

METHODS

In this cross-sectional interview-based questionnaire study, patients from 3 different pain treatment centers in Vienna aged 18-65 years, with pain lasting 3 months or longer were asked to participate. The association between the short-form McGill pain questionnaire (SF-MPQ) and sleep quality (sleep onset latency, interrupted sleep due to pain, sleep duration and recovering effect of sleep) was assessed.

RESULTS

In this study 121 patients (male 32, female 89, mean age 49 ± 9 years) could be analyzed. Of the patients 38.8% needed more than 30 min for falling asleep, 63.6% reported sleep fragmentation, 30.6% slept less than 5 h and 60.3% reported no recovering effect of sleep. The strongest associations between pain characteristics and sleep quality were found for pain intensity and affective pain aspects. Logistic regression analyses revealed that one point more in the total score of SF-MPQ increased the odds of needing more than 30 min for falling asleep, waking up more than 3 times due to pain, sleeping less than 5 h, and perceiving the sleep as non-recovering, by 6%. Adjusting for physical and psychological quality of life lowered the odds ratios and the association was no longer significant.

CONCLUSION

The results underline the importance of paying attention to sleep quality in patients with chronic pain. The results also indicate that psychological factors might mediate the association between pain and sleep quality.

Childhood adversity, adult socioeconomic status and risk of work disability: a prospective cohort study

OBJECTIVES

To examine the combined effects of childhood adversities and low adult socioeconomic status (SES) on the risk of future work disability.

METHODS

Included were 34 384 employed Finnish Public Sector study participants who responded to questions about childhood adversities (none vs any adversity, eg, parental divorce or financial difficulties) in 2008, and whose adult SES in 2008 was available. We categorised exposure into four groups: neither (reference), childhood adversity only, low SES only or both. Participants were followed from 2009 until the first period of register-based work disability (sickness absence >9 days or disability pension) due to any cause, musculoskeletal or mental disorders; retirement; death or end of follow-up (December 2011). We ran Cox proportional hazard models adjusted for behavioural, health-related and work-related covariates, and calculated synergy indices for the combined effects.

RESULTS

When compared with those with neither exposure, HR for work disability from any cause was increased among participants with childhood adversity, with low SES, and those with both exposures. The highest hazard was observed in those with both exposures: HR 2.53, 95% CI 2.29 to 2.79 for musculoskeletal disability, 1.55, 95% CI 1.36 to 1.78 for disability due to mental disorders and 1.29, 95% CI 1.20 to 1.39 for disability due to other reasons. The synergy indices did not indicate synergistic effects.

CONCLUSIONS

These findings indicate that childhood psychosocial adversity and low adult SES are additive risk factors for work disability.

Socioeconomic inequalities in treatment of individuals with common mental disorders regarding subsequent development of mental illness

PURPOSE

Socioeconomic differences appear to be reflected in both, the development and the treatment of common mental disorders (CMDs, i.e. depressive, anxiety and stress-related disorders). Underlying mechanisms of these inequalities are to date not fully understood. This study aimed to investigate if (1) there are socioeconomic differences with regard to type of treatment and (2) if the socioeconomic status modifies the association between treatment and subsequent inpatient care or suicide attempt, respectively, in individuals with CMDs.

METHODS

The study population comprised 66,097 individuals aged 18-59 on sick-leave due to a CMD during 2006 in Sweden. Cox regression with a follow-up from 2007 through 2010 estimated crude and multivariate hazard ratios (HR) with 95% confidence intervals (CI).

RESULTS

Individuals with sickness absence due to CMDs and a higher educational level were had a lower proportions of specialised health care and combined psychiatric medication than their counterparts with lower education. However, if high educated CMD patients received more combined medication, associations with subsequent mental inpatient care (p < 0.01) and suicide attempt (p < 0.05) were stronger than for their counterparts with low education. Moreover, previous inpatient care due to mental disorders was associated with higher HRs of subsequent suicide attempt in CMD patients with high education (HR 5.88; CI 3.02-11.45) compared to those with low education (1.96; 1.06-3.60).

CONCLUSION

Findings suggest that socioeconomic inequalities shape differences in treatment measures and mental health development in individuals with CMDs. These differences might signal discrepancies in treatment per se or reflect morbidity differences requiring different treatment regimens, or may be due to the fact that different diagnoses are given in different educational strata due to differential role of stigma.

How are socio-demographic and psycho-social factors associated with the prevalence and chronicity of severe pain in 14 different body sites? A cross-sectional population-based survey

BACKGROUND

Severe pain and chronic pain have a high impact on individuals and society. Body location of pain is important with regard to perception, articulation, and underlying biological, mental or social causes of pain.

METHODS

A cross-sectional survey was performed in the general Austrian population with 15,474 personally interviewed subjects aged 15 years and older.

RESULTS

The 1‑year period prevalence of severe pain in any body site was 38.6% and of chronic pain 24.9%. In all, 8.1% had pain in at least three body sites. Subjects aged 65 years and older (52.2%), those with low education (43.4%), unemployed subjects (50.4%), retired subjects (52.4%), those with anxiety/depression (67.7%), and subjects with lack of social support (49.6%) were sub-populations with high pain prevalence. In multivariate analyses, depression/anxiety was associated with prevalence and chronicity of severe pain in all body sites (range of ORs 1.89-5.01), while such associations were found for lack of social support (range of ORs 1.33-1.65), female sex (range of ORs 1.38-2.34), higher age (range of ORs 1.09-1.18 for 5 year intervals), as well as low educational (range of ORs 1.47-2.06 primary vs. tertiary education) and unemployment status (range of ORs 1.50-2.62) in most body sites. Being born in non-EU or EFTA states was associated with pain in many body sites (range of ORs 1.38-2.10).

CONCLUSIONS

Psychosocial factors are associated with pain presence in similar ways irrespective of location. Regarding socio-demographic factors, differences towards the magnitude and the direction in the association with pain frequency and chronicity in different body sites emerged.