The interplay between multisite pain and insomnia on the risk of anxiety and depression: the HUNT study

Paul Jarle Mork,Anna Marcuzzi,Eivind Schjelderup Skarpsno,Tom Ivar Lund Nilsen

doi:10.1186/s12888-022-03762-0

Paul Jarle Mork, Anna Marcuzzi + Show 2 more

Open Access

https://doi.org/10.1186/s12888-022-03762-0

Copy DOI

Abstract

BackgroundChronic musculoskeletal pain and insomnia frequently co-occur and are known independent risk factors for anxiety and depression. However, the interplay between these two conditions on the risk of anxiety and depression has not been explored.MethodsA population-based prospective study of 18,301 adults in the Norwegian HUNT Study without anxiety or depression at baseline (2006–2008). We calculated adjusted risk ratios (RRs) with 95% confidence intervals (CIs) for anxiety and/or depression at follow-up (2017–2019), associated with i) number of chronic pain sites, and ii) chronic pain and insomnia symptoms jointly.ResultsAt follow-up, 2155 (11.8%) participants reported anxiety and/or depression. The number of pain sites was positively associated with risk of anxiety and/or depression (Ptrend, < 0.001). Compared to people without chronic pain and insomnia symptoms, people with ≥5 pain sites and no insomnia symptoms had a RR of 1.52 (95% CI: 1.28 to 1.81) for anxiety and/or depression, those with no chronic pain but with insomnia had a RR of 1.78 (95% CI: 1.33 to 2.38), whereas the RR among people with both ≥5 pain sites and insomnia was 2.42 (95% CI: 1.85 to 3.16). We observed no synergistic effect above additivity for the combination of ≥5 pain sites and insomnia on risk of anxiety and/or depression.ConclusionsThis study shows that people with multisite chronic pain who also suffer from insomnia are at a particularly high risk for anxiety and/or depression, suggesting that insomnia symptoms are important contributors to the association between multisite pain and common mental health problems.

Highlights

Anxiety and depression are highly prevalent conditions and significant contributors to the disability burden worldwide [1]
Our study indicates a positive association between number of chronic musculoskeletal pain sites and risk of anxiety and depression
Our finding that people with multisite chronic pain are at higher long-term risk of anxiety and depression is in line with the study by Gerrits et al [11], showing a 29% increased risk of anxiety and depressive disorders among people who reported an increase in number of pain sites over a 4-year period

Summary

Introduction

Anxiety and depression are highly prevalent conditions and significant contributors to the disability burden worldwide [1]. The adverse impact of anxiety and Population-based research has shown that chronic pain is associated with increased risk of depression [5,6,7,8,9,10] and anxiety [9,10,11], and this effect seems to be more pronounced when higher pain severity or activity interfering pain was reported. Musculoskeletal pain most often occurs in more than one body site. One study found a positive association between the number of pain sites and the onset of anxiety and depression [11], suggesting that multisite pain is an important risk factor for mental health problems. Chronic musculoskeletal pain and insomnia frequently co-occur and are known independent risk factors for anxiety and depression. The interplay between these two conditions on the risk of anxiety and depression has not been explored

Objectives

Methods

Results

Discussion

Conclusion