Psychological Distress in Early Childhood and the Risk of Adolescent Spinal Pain with Impact: A Longitudinal Cohort Study

Abstract

Background: Spinal pain (SP), including neck and back pain, is common and often associated with substantial functional interference (e.g. school absenteeism), poor mental health and reduced quality of life of adolescents. Contemporary understanding of SP favours a biopsychosocial approach, and emerging evidence suggests stronger influence of psychological rather than other factors. We aimed to investigate if experiencing psychological distress in early childhood increases the risk of spinal pain with impact during adolescence. Methods: 1175 adolescents from a prospective cohort study (Raine Study Gen2) were included. Psychological distress was assessed at ages 2, 5, 8 and 10 using Child Behaviour Check List (CBCL). CBCL total and subscale scores (internalising and externalising symptoms) were converted to age-standardized scores and dichotomized according to t-scores (>60 = high distress). Spinal pain, including low back, mid back, or neck/shoulder, was measured at age 17. We were interested in adolescent SP with impact (care seeking, medication use, school absenteeism, daily activity interference, leisure activity interference) and defined cases as SP with impact (one or more) or greater impact (two or more) impacts. We investigated the longitudinal associations between childhood psychological distress and adolescent SP using univariate and multivariable logistic regression models. Sex was tested as a moderator and confounders were: child sex, age, body mass index, physical activity, sedentary behaviour, family pain history, income and maternal education. Findings: The prevalence of adolescent SP with impact and greater impact were 49% and 14%, respectively. Psychological distress in childhood increased the odds of adolescent SP with impact by 33% (adjusted OR 1.33; 95% CI 1.01 to 1.76). We found similar, significant associations for internalizing and externalizing symptoms after adjusting for a range of potential child and family confounders. Interpretation: Psychological distress in childhood increases the risk of SP with impact in adolescence and may be a promising prevention target. Funding Statement: The core management of the Raine Study is funded by The University of Western Australia (UWA), Raine Medical Research Foundation; Telethon Kids Institute; Women and Infants Research Foundation; Curtin University; Murdoch University, The University of Notre Dame Australia and Edith Cowan University. The 17 year Raine Study follow up was funded by the National and Medical Research Council (NHMRC) programme grant 353514 and NMHRC project grant 323200. Declaration of Interests: The authors stated: None. Ethics Approval Statement: The authors obtained ethics approval for this study from the Curtin University Human Research Ethics Committee and the Princess Margaret Hospital Human Research Ethics Committee (HR84/2005). Consent was gained from the participants’ guardians.