title: Synergistic effect between back pain and common mental disorders and the risk of future disability pension: a nationwide study from Sweden.
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).
  
  
  METHODS
  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.
authors.affiliation: Institute of Social Medicine,Centre for Public Health,Medical University of Vienna,Vienna,Austria,Wien,Austria.
authors.forename: T E
authors.initials: TE
authors.lastname: Dorner
authors.affiliation: Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,Stockholm,Sweden.
authors.forename: K
authors.initials: K
authors.lastname: Alexanderson
authors.affiliation: Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,Stockholm,Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Svedberg
authors.affiliation: Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,Stockholm,Sweden.
authors.forename: P
authors.initials: P
authors.lastname: Tinghög
authors.affiliation: Finnish Institute of Occupational Health,Topeliuksenkatu,Helsinki,Finland.
authors.forename: A
authors.initials: A
authors.lastname: Ropponen
authors.affiliation: Department of Clinical Neuroscience,Division of Insurance Medicine,Karolinska Institutet,Stockholm,Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Mittendorfer-Rutz
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D001416:Back Pain / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology; D010415:Pensions / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011632:Public Assistance / Q000706:statistics & numerical data*; D012307:Risk Factors; D013001:Somatoform Disorders / Q000453:epidemiology; D013548:Sweden; D055815:Young Adult
keywords: Back pain; common mental disorders; disability pension; insurance medicine; sick leave; synergy index