Abstract
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.
Highlights
Pain affects over 20% of the adult population and is the most common cause of long-term physical disability, and a substantial burden to both individuals and societies.[12,29] the increasing trends in common mental disorders (CMDs), such as depression and anxiety, are currently of great concern globally
Intraclass correlations among opposite-sexed DZ twins were lower as compared to same-sexed DZ twins for CMD and sickness absence (SA)/disability pension (DP), suggesting that the estimates may be different among women and men
Cross-twin cross-trait correlations were higher among MZ twins as compared to DZ twins, suggesting that genetic influences were of importance for the covariance between the phenotypes
Summary
Pain affects over 20% of the adult population and is the most common cause of long-term physical disability, and a substantial burden to both individuals and societies.[12,29] the increasing trends in common mental disorders (CMDs), such as depression and anxiety, are currently of great concern globally. Previous research suggests that pain and depression are strongly interlinked.[6,7,17] In Europe, up to one-third of persons with chronic pain, most frequently back pain, have been diagnosed with depression.[5,24] whether mental disorders are a cause or a consequence of pain still remains unsolved. Anxiety may be a predictor of pain, whereas depression is claimed to be linked to the natural course of pain,[32,47] potentially being a consequence of pain.[23,43] a bidirectional link between pain and depression has been previously discussed and suggested to be attributable to shared underlying neurobiological and psychosocial factors.[10]
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