Abstract
BackgroundChronic widespread pain (CWP) and common mental disorders (CMDs) are common public health problems, but little is known about the role of CWP and CMDs on future adverse outcomes among work disabled individuals. The aims of the study were to investigate the associations between CWP and CMDs with subsequent disability pension (DP), long-term unemployment (> 90 days) and all-cause mortality in individuals with sickness absence (SA) and whether the associations were explained by familial factors.MethodsIn this prospective cohort study, 7884 Swedish twins born between 1933 and 1985 were included and baseline data were gathered from a questionnaire in 1998 to 2006. Register data were used for obtaining information regarding demographics, SA, DP, unemployment and mortality. Cox proportional hazards regressions were used to calculate Hazard Ratios (HR) with 95% Confidence Intervals (CI) for the associations between CWP and/or CMDs with DP, unemployment and mortality, while conditional Cox models for twin pairs provided control for familial confounding.ResultsHaving either CWP or CMDs among those with a history of SA was associated with a higher risk of DP and all-cause mortality than individuals without CWP and CMDs after controlling for socio-demographic and health factors. Moreover, sick-listed individuals with both CWP and CMDs had a higher risk of DP while those who only had CMDs had a higher risk of long-term unemployment compared to those without CWP and CMDs. The association between CMDs with DP and long-term unemployment was no longer significant when controlling for familial factors.ConclusionsCMDs was a risk factor for DP, unemployment and mortality among individuals with SA, while CWP seems to be important in relation to future DP and mortality. Familial factors played a role in the associations between CMDs and DP and CMDs and unemployment.
Highlights
Chronic widespread pain (CWP) and common mental disorders (CMDs) are common public health problems, but little is known about the role of CWP and CMDs on future adverse outcomes among work disabled individuals
In Model 1, we adjusted for sociodemographic factors including sex, age, education, children living at home, type of living area and cohort effect and the Hazard Ratios (HR) for disability pension (DP) showed somewhat of changes, indicating some influence from socio-demographic factors on the associations
The increased risk of DP remained even after additional control for health-related factors, for those having only CWP (HR: 2.43, 95% Confidence Intervals (CI): 2.03–2.93) and both CWP and CMDs (HR: 2.65, 95% CI: 1.89–3.71)
Summary
Chronic widespread pain (CWP) and common mental disorders (CMDs) are common public health problems, but little is known about the role of CWP and CMDs on future adverse outcomes among work disabled individuals. The aims of the study were to investigate the associations between CWP and CMDs with subsequent disability pension (DP), long-term unemployment (> 90 days) and all-cause mortality in individuals with sickness absence (SA) and whether the associations were explained by familial factors. The most common reason for individuals with a complaint of CWP is fibromyalgia, but this pain complaint can be a symptom of other diseases than fibromyalgia, indicating consideration of a differential diagnosis [2]. As a disabling condition CWP might cause temporary and permanent work disability in terms of sickness absence (SA) and disability pension (DP). CWP, SA and DP are associated with a high economic and social burden for both the patients and the health care system which illustrates the necessity of further knowledge on the associations between CWP and work disability
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