Association of stress and depression with chronic facial pain: A case-control study based on the Northern Finland 1966 Birth Cohort.
OBJECTIVE
The aim was to study the association between stress level and chronic facial pain, while controlling for the effect of depression on this association, during a three-year follow-up in a general population-based birth cohort.


METHODS
In the general population-based Northern Finland 1966 Birth Cohort, information about stress level, depression and facial pain were collected using questionnaires at the age of 31 years. Stress level was measured using the Work Ability Index. Depression was assessed using the 13-item depression subscale in the Hopkins Symptom Checklist-25. Three years later, a subsample of 52 subjects (42 women) with chronic facial pain and 52 pain-free controls (42 women) was formed.


RESULTS
Of the subjects having high stress level at baseline, 73.3% had chronic facial pain, and 26.7% were pain-free three years later. The univariate logistic regression analysis showed that high stress level at 31 years increased the risk for chronic facial pain (crude OR 6.1, 95%, CI 1.3-28.7) three years later. When including depression in a multivariate model, depression associated statistically significantly with chronic facial pain (adjusted OR 2.5, 95%, CI 1.0-5.8), whereas stress level did not (adjusted OR 2.3, 95%, CI 0.6-8.4).


CONCLUSIONS
High stress level is connected with increased risk for chronic facial pain. This association seems to mediate through depression.
a Institute of Dentistry , University of Oulu , Oulu , Finland.
Netta
N
Nevalainen
a Institute of Dentistry , University of Oulu , Oulu , Finland.|b Oral and Maxillofacial Department , Medical Research Center Oulu, Oulu University Hospital , Oulu , Finland.
Raija
R
Lähdesmäki
c Department of Psychiatry , Research Group for Clinical Neuroscience, University of Oulu and Oulu University Hospital , Oulu , Finland.|d Department of Psychiatry , Länsi-Pohja Healthcare District , Kemi , Finland.|e Department of Psychiatry , The Middle Ostrobothnia Central Hospital , Kiuru , Finland.|f Mental Health Services , Joint Municipal Authority of Wellbeing in Raahe District , Raahe , Finland.|g Mental health services, Basic Health Care District of Kallio and Visala Hospital , The Northern Ostrobothnia Hospital District , Ylivieska , Finland.
Pirjo
P
Mäki
h Institute of Health Sciences , University of Oulu , Oulu , Finland.|i Department of Psychology , University of Jyväskylä , Jyväskylä , Finland.
Ellen
E
Ek
h Institute of Health Sciences , University of Oulu , Oulu , Finland.|j Unit of General Practice , Oulu University Hospital , Oulu , Finland.
Anja
A
Taanila
a Institute of Dentistry , University of Oulu , Oulu , Finland.
Paula
P
Pesonen
a Institute of Dentistry , University of Oulu , Oulu , Finland.|b Oral and Maxillofacial Department , Medical Research Center Oulu, Oulu University Hospital , Oulu , Finland.|k Institute of Dentistry , University of Eastern Finland , Kuopio , Finland.|l Oral and Maxillofacial Department , Kuopio University Hospital , Kuopio , Finland.
Kirsi
K
Sipilä
D000328:Adult; D016022:Case-Control Studies; D059350:Chronic Pain / Q000209:etiology* / Q000523:psychology*; D015331:Cohort Studies; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology*; D005157:Facial Pain / Q000209:etiology* / Q000523:psychology*; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D012307:Risk Factors; D013315:Stress, Psychological / Q000150:complications* / Q000523:psychology*; D011795:Surveys and Questionnaires
Depression; Facial pain; NFBC 1966; Stress; TMD; Temporomandibular disorder