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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

Published online by Cambridge University Press:  15 October 2015

T. E. Dorner ,
K. Alexanderson ,
P. Svedberg ,
P. Tinghög ,
A. Ropponen  and
E. Mittendorfer-Rutz
T. E. Dorner*
Affiliation:
Institute of Social Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria, Wien, Austria
K. Alexanderson
Affiliation:
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
P. Svedberg
Affiliation:
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
P. Tinghög
Affiliation:
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
A. Ropponen
Affiliation:
Finnish Institute of Occupational Health, Topeliuksenkatu, Helsinki, Finland
E. Mittendorfer-Rutz
Affiliation:
Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
*
* Address for correspondence: Dr T. E. Dorner, Institute of Social Medicine, Centre for Public Health, Medical University Vienna, Vienna, Austria, Kinderspitalgasse 15/I, 1090 Wien, Austria. (Email: thomas.dorner@meduniwien.ac.at)
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Abstract

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.

Keywords

Back paincommon mental disordersdisability pensioninsurance medicinesick leavesynergy index
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 2 , January 2016 , pp. 425 - 436
Copyright
Copyright © Cambridge University Press 2015 

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