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

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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