Background & Aims
Both pain and mental health conditions are common complaints in children and young people requiring primary care consultations [1-7]. The complaints can negatively influence social relations, quality of life and school attendance as well as performance [8-15]. For both conditions, studies have shown differences between the sexes, where girls report and seek more healthcare both for pain [1, 3, 16] and mental health conditions [5, 17]. Although, the two conditions often co-occur, less is known about the temporal relationship and whether both conditions may pose a risk to each other.
The aim of this study was therefore to study the temporal relationship between pain and mental health conditions in young people.
Methods
In Region Skåne, the southernmost part of Sweden with a population of 1.4 million, healthcare is publicly financed and free of charge for all children up to the age of 18. Using electronic health records covering all delivered care in the region – the Skåne healthcare register – we identified and followed children and young people aged 7-18 years over a 13-year period (2007-2019) and tracked all their registered diagnoses.
Using Poisson’s regression modelling, we analyzed the incidence rate ratio (IRR) of being diagnosed with mental health conditions after an initial diagnosis of pain and the IRR of being diagnosed with pain after an initial diagnosis of a mental health condition. We also stratified the regression analyses by sex and age, i.e. included sex and age-groups as effect modifiers and presented the results separately by sex and four different age-groups.
Results
The cohort included 83,126 individuals without diagnoses for pain and mental health conditions at the start of the study period (47% women). In total, 62% were registered with a pain diagnosis and 26% with a mental health condition during the study period.
The incidence rate ratio (IRR) for receiving a diagnose of a mental health condition after a pain diagnosis was 2.86 (95% CI 2.78-2.94) compared to those not having pain, adjusted for age, sex and previous number of healthcare consultations.
The adjusted IRR for a pain diagnosis after a diagnosis of a mental health condition compared to not having a mental health condition was 1.57 (95% CI=1.52-1.63). When stratified by age, the risk estimates were highest in the youngest age-group and then progressively decreased the older the age-group, both when mental health conditions and pain were the risk factors. Notably, when stratified by sex, the IRR estimates was consistently higher among girls.
Conclusions
Young individuals with pain had a threefold increased risk of developing mental health conditions while the risk of developing pain after a mental health condition was considerably lower although still elevated as compared the reference group in the general population. In other words, both pain and mental health conditions pose a future risk for one another. The risk estimates were highest in the youngest age group and among girls, thereby being particularly vulnerable.
This points to the importance of paying attention to both conditions when an individual consults for either condition in order to early detect any tendency to develop the other condition.
References
- Gobina, I., et al., Prevalence of self-reported chronic pain among adolescents: Evidence from 42 countries and regions. Eur J Pain, 2018. 23: p. 316-326.
- Prathivadi Bhayankaram, N., et al., Musculoskeletal consultations from childhood to adulthood: a longitudinal study. J Public Health (Oxf), 2020. 42(4): p. e428-e434.
- Bondesson, E., et al., Consultation prevalence among children, adolescents and young adults with pain conditions: A description of age- and gender differences. Eur J Pain, 2020. 24: p. 649-658.
- Polanczyk, G.V., et al., Annual research review: A meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry, 2015. 56(3): p. 345-65.
- Frey, M., et al., Age and sex specific incidence for depression from early childhood to adolescence: A 13-year longitudinal analysis of German health insurance data. J Psychiatr Res, 2020. 129: p. 17-23.
- Castelpietra, G., et al., The burden of mental disorders, substance use disorders and self-harm among young people in Europe, 1990-2019: Findings from the Global Burden of Disease Study 2019. Lancet Reg Health Eur, 2022. 16: p. 100341.
- Larrosa Pardo, F., Epidemiological register studies on pain : -etiology, treatment, and mental health [dissertation]. 2023, Lund: Clinical Sciences, Lund, Faculty of Medicine, Lund University.
- Sawyer, M.G., et al., Health-related quality of life of children and adolescents with mental disorders. J Am Acad Child Adolesc Psychiatry, 2002. 41(5): p. 530-7.
- O’Loughlin, R., et al., The relationship between physical and mental health multimorbidity and children’s health-related quality of life. Qual Life Res, 2022. 31(7): p. 2119-2131.
- Petersen, S., B.L. Hagglof, and E.I. Bergstrom, Impaired health-related quality of life in children with recurrent pain. Pediatrics, 2009. 124(4): p. e759-67.
- Finning, K., et al., Emotional disorder and absence from school: findings from the 2004 British Child and Adolescent Mental Health Survey. Eur Child Adolesc Psychiatry, 2020. 29(2): p. 187-198.
- Grimby-Ekman, A., et al., Pain could negatively affect school grades – Swedish middle school students with low school grades most affected. PLoS One, 2018. 13(12): p. e0208435.
- Groenewald, C.B., M. Giles, and T.M. Palermo, School Absence Associated with Childhood Pain in the United States. Clin J Pain, 2019. 35: p. 525-531.
- John, A., et al., Association of school absence and exclusion with recorded neurodevelopmental disorders, mental disorders, or self-harm: a nationwide, retrospective, electronic cohort study of children and young people in Wales, UK. Lancet Psychiatry, 2022. 9(1): p. 23-34.
- Ragnarsson, S., et al., Recurrent Pain and Academic Achievement in School-Aged Children: A Systematic Review. J Sch Nurs, 2020. 36(1): p. 61-78.
- Kamper, S.J., T.P. Yamato, and C.M. Williams, The prevalence, risk factors, prognosis and treatment for back pain in children and adolescents: An overview of systematic reviews. Best Pract Res Clin Rheumatol, 2016. 30(6): p. 1021-1036.
Presenting Author
Elisabeth Bondesson
Poster Authors
Elisabeth Bondesson (PhD)
RPT, PhD
Department of clinical sciences Lund, Lund university, Lund Sweden
Lead Author
Beata Borgström Bolmsjö
MD
Center for Primary Health Care Research, Dep. of Clinical Sciences, Malmö, Lund University, Sweden
Lead Author
Fabian Larrosa Pardo (MD PhD)
Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
Lead Author
Anna Jöud
Department of Clinical Sciences Lund, Ortopedics, Lund University, Lund, Sweden
Lead Author
Topics
- Epidemiology