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Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden.
Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria.
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet.ORCID iD: 0000-0001-6138-6427
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2016 (English)In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 2Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to analyse a possible synergistic effect between back pain and common mental disorders (CMDs) in relation to future disability pension (DP).

METHOD: All 4 823 069 individuals aged 16-64 years, living in Sweden in December 2004, not pensioned in 2005 and without ongoing sickness absence at the turn of 2004/2005 formed the cohort of this register-based study. Hazard ratios (HRs) and 95% confidence intervals (CIs) for DP (2006-2010) were estimated. Exposure variables were back pain (M54) (sickness absence or inpatient or specialized outpatient care in 2005) and CMD (F40-F48) [sickness absence or inpatient or specialized outpatient care or antidepressants (N06a) in 2005].

RESULTS: HRs for DP were 4.03 (95% CI 3.87-4.21) and 3.86 (95% CI 3.68-4.04) in women and men with back pain. HRs for DP in women and men with CMD were 4.98 (95% CI 4.88-5.08) and 6.05 (95% CI 5.90-6.21). In women and men with both conditions, HRs for DP were 15.62 (95% CI 14.40-16.94) and 19.84 (95% CI 17.94-21.94). In women, synergy index, relative excess risk due to interaction, and attributable proportion were 1.24 (95% CI 1.13-1.36), 0.18 (95% CI 0.11-0.25), and 2.08 (95% CI 1.09-3.06). The corresponding figures for men were 1.45 (95% CI 1.29-1.62), 0.29 (95% CI 0.22-0.36), and 4.21 (95% CI 2.71-5.70).

CONCLUSIONS: Co-morbidity of back pain and CMD is associated with a higher risk of DP than either individual condition, when added up, which has possible clinical implications to prevent further disability and exclusion from the labour market.

Place, publisher, year, edition, pages
2016. Vol. 46, no 2
Keyword [en]
Back pain; common mental disorders; disability pension; insurance medicine; sick leave; synergy index
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
URN: urn:nbn:se:rkh:diva-2154DOI: 10.1017/S003329171500197XPubMedID: 26467609OAI: oai:DiVA.org:rkh-2154DiVA: diva2:902068
Available from: 2016-02-10 Created: 2016-02-10 Last updated: 2016-02-10Bibliographically approved

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