Patricia Olaya-Contreras

Comparison between the Beck Depression Inventory and psychiatric evaluation of distress in patients on long-term sick leave due to chronic musculoskeletal pain

Background: Chronic musculoskeletal pain (CMP) is associated with psychological distress and long-term disability. Underlying diagnoses causing long-term sickness absence due to CMP have not been explored enough. In a somatic health care setting, it is important to identify mental health comorbidity to facilitate the selection of appropriate treatment. The objectives of this study were to compare the scores of depressed mood obtained on the Beck Depression Inventory (BDI) with the diagnosis of depression made by a psychiatrist, and to study the prevalence of undiagnosed mental health comorbidity in these patients. Methods and patients: 83 consecutive patients on sick leave (mean duration 21 months) due to CMP who had been referred by the Social Insurance Office to an orthopedist and a psychiatrist for assessment of the patient’s diagnoses and capacity to work. The mean age was 45 (23–61) years, 58% were women and 52% were immigrants. The accuracy of measurements was calculated using the Diagnostic Statistical Manual of Mental Disorders IV as the Gold standard. Results: Psychiatric illness was diagnosed in 87% of the patients. The diagnosis was depression in 56%, other psychiatric illnesses in 31%, whereas 13% were mentally healthy. Of all the patients, only 10% had a previous psychiatric diagnosis. The median value of the BDI score was 26 points in depressed patients, whereas it was 23 in patients with other psychiatric diagnoses. The sensitivity of the BDI to detect depression was 87.5%. We found good agreement between the BDI score and a diagnosis of depression. Conclusion: Undiagnosed psychiatric disorders were commonly seen in patients with CMP. The high sensitivity of the BDI scores enables the screening of mental health comorbidity in patients with a somatic dysfunction. The test is a useful tool for detecting distress in patients who are on long-term sick leave due to CMP and who need additional treatment.

Biopsychosocial function analyses changes the assessment of the ability to work in patients on long-term sick-leave due to chronic musculoskeletal pain: the role of undiagnosed mental health comorbidity.

Aims: To study the prevalence of somatic and mental health comorbidity and the use of opioid medication among patients on long-term sick-leave due to chronic musculoskeletal pain (CMP); to compare an orthopaedic-based assessment of ability to work with a team assessment; to investigate the relationship between intensity of pain and psychosocial characteristics in this group. Methods: A cross-sectional study was carried out with 174 consecutive patients on sick-leave for a mean of 21 months. All were referred from the Social Insurance Office for orthopaedic evaluation and assessment of the ability to work. Of them, only 83/174 patients were referred by the Office for psychiatric evaluation. Results: Neck pain was the main cause of disability. Patients with neck pain often suffered pain in more than two sites, and greater intensity of pain. Thirty-four percent of all participants had been prescribed opioid medication before consultation. Degrees of disability, unemployment, low degree of education and to be an immigrant were related to intensity of pain. Unrecognized psychiatric disorders changed the main cause of inability to work in 69% of patients who underwent both orthopaedic and psychiatric evaluation. Conclusions: An evaluation based on biopsychosocial function is valuable in reaching an accurate assessment of the patient’s diagnosis, and ability to work in CMP. Ability to work and degree of sick-leave in patients on long-term sick-leave is determined to a large extent by undiagnosed mental health comorbidities, and not solely somatic complaints.

Colombian Children With Overweight and Obesity Need Additional Motivational Support at School to Perform Health-Enhancing Physical Activity.

AIMS The aim of this study is to investigate associations of screen-time and physical activity (PA) with self-efficacy for PA, intrinsic motivation to PA and health-related quality of life (HRQoL) in Colombian schoolchildren from socioeconomically disadvantaged neighborhoods, and to compare these variables among children with normal-weight (NW), overweight (OW) and obesity (OB). METHODS In 678 schoolchildren (age 10-14 years) screen-time (TV, video games, computer) and number of days being physically active ≥ 60 minutes were self-reported. Multi-item scales were used to assess self-efficacy to PA and intrinsic motivation to PA. The KIDSCREEN-27 was used to assess HRQoL. RESULTS Screen-time was associated with HRQoL in the school/learning environment dimension. Number of days being physically active was associated with self-efficacy for PA, intrinsic motivation for PA and with HRQoL concerning physical well-being, autonomy/parent relation and social support/peers. Group differences were found for days being physically active (OW = 2.8 and OB = 2.7 vs. NW = 3.3) but not for screen-time (NW = 5.0, OW = 4.7 and OB = 5.7 hrs·d-1). OW and OB scored lower on intrinsic motivation to PA than NW (OW = 19.2 and OB = 17.9 versus NW = 20.1). All 3 groups differed in physical well-being scores (NW = 50.3, OW = 48.1, OB = 40.6, P < .001). CONCLUSIONS Schoolchildren with overweight and obesity from socioeconomically disadvantaged neighborhoods need additional motivational support to perform health-enhancing PA to experience higher physical well-being.

Illness behavior in patients on long-term sick leave due to chronic musculoskeletal pain.

Background and purpose Methods for identification of patients with illness behavior in orthopedic settings are still being debated. The purpose of this study was to test the association between illness behavior, depressed mood, pain intensity, self-rated disability, and clinical status in patients with chronic musculoskeletal pain (CMP). Methods We examined 174 consecutive sick-listed patients (90 women). Musculoskeletal function was estimated by range of motion, muscle strength, and motor and sensory function. The degree of illness behavior was measured by Waddell signs (WS). Results WS were observed in 47/174 (27%) of the patients, 16% of whom manifested excessive illness behaviour. In general, more patients with WS were depressed (OR = 4.4; 95% CI: 1.8–11) and experienced greater pain (OR = 2.9; CI: 1.1–7.7). No abnormal physical function could be observed in two-thirds of the patients. Other predictive factors for manifesting WS at the clinical examinations were longer sick leave and previous full sick leave (p < 0.05). Interpretation Excessive illness behavior is related to psychological distress in patients with CMP and long-term disability. Thus, some patients may also require psychological assessment. Looking for WS during consultation is useful for targeting other factors that may be important in the diagnostic process.

Cross-validation of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) for clinical use.

ObjectiveThe main objective of this study was to investigate different psychometric properties of the Swedish version of the Depression, Anxiety, and Positive Outlook Scale (DAPOS) in patients with chronic musculoskeletal pain in an orthopedic setting. MethodsA total of 449 participants took part in the study, including 288 patients with chronic musculoskeletal pain and 161 participants in a reference group. Internal consistency, convergent validity, and measurement invariance of the constructs of DAPOS were investigated across sex and diagnostic groups. The Beck Depression Inventory and the Spielberger Anxiety Inventory were used for measures of convergent validity. Multigroup confirmatory factor analysis was performed to test measurement invariance of the theoretical constructs of DAPOS. ResultsInternal consistency was good for all 3 constructs, and correlations concerned with convergent validity were found to be acceptable to good. With regard to cross-validation, the 3 constructs of DAPOS were strictly measurement invariant with respect to sex. Across diagnostic groups, the constructs of anxiety and positive outlook were almost strictly measurement invariant, although there were some restrictions of measurement invariance for the construct of depression. DiscussionTo be able to rely on an instrument with as few items as DAPOS, the cross-validation of its constructs for sex and diagnostic groups is a valuable information, particularly when investigated in patients with musculoskeletal pain. Based on these results, we recommend that DAPOS could replace longer and more time-consuming screening tests in clinical settings.

Perceptions and Practices of Physical Activity Among Colombian Overweight/Obese Schoolchildren

The purpose of this study was to explore the contexts that shape obese children’s engagement in physical activity (PA) focusing on children’s perceptions. The qualitative design consisted of non-participant observations, and unstructured and semi-structured focus group and individual interviews. Data were analyzed by use of conventional content analysis. Participants were overweight/obese children from a public school in Colombia. The findings show that the main context where PA took place was during physical education (PE) classes at school and in the children’s neighborhoods. The participants perceived the PE classes to be too competitive and demotivating. PA taking place outside school was associated with fun, but occurred only on an infrequent basis and was challenged by living in insecure neighborhoods. Adapting a health promotion approach that emphasizes participation and social environments might motivate obese children to become physically active at school as well as during leisure time.

Physical Inactivity among Danish and Colombian Adolescents with Lower Level of Family Affluence.

BACKGROUND & OBJECTIVES This study aimed to assess levels of physical activity (PA) and sedentary behaviours among Danish and Colombian adolescents, and to compare relevant environmental and psychosocial factors associated with physical inactivity (PI) between both student groups. Further, we aimed to compare PI between Danish students born in Denmark and those with immigrant background living in Denmark, but born in another country. METHODS The comparative study was performed with 1.374 Danish adolescents (among them 152 born outside the country) who participated in the Danish Youth Cohort and 452 Colombian students who completed the ISCOLE questionnaire, both from the most disadvantaged socioeconomic strata. RESULTS The prevalence of physical inactivity (PI) was much higher among Colombian students (74.6%) compared with Danish (25.2%) and with students with a non-Danish background living in Denmark (21.1%). Both groups of Danish adolescents participated more often in organized sports, spent more time on sports after school, were more likely to actively commute to school compared to Colombians and spent less time on screen viewing than Colombians did. In both Columbian and Danish students, low time spent on sports after school, and poorer self-perceived health, were associated with PI. Sedentary behaviours (time in front of screen) were also positively associated with PI. CONCLUSION Most Colombian adolescents were not meeting the recommendation of accumulating at least 60 minutes per day of moderate-to-vigorous intensity PA for positive health outcomes as most Danish adolescents did independently of their ethnic background. We assume that the physical and social environment in the neighbourhoods where adolescents live may explain the differences in levels of PA between the countries.

THE INFLUENCE OF DISTRESS ON DISABILITY, PHYSICAL ACTIVITY AND PAIN INTENSITY AFTER 7 DAYS OF ACUTE SEVERE LOW BACK PAIN

Low back pain (LBP) is described as highly recurrent and frequently persistent public health worldwide. The “stay active” concept has been regarded as the most appropriate treatment recommendation for patients with acute LBP. The objective of this study was to evaluate the influence of distress on disability, physical activity and pain intensity in subjects with severe acute LBP. Methods A Randomised Control Trial (RCT) was conducted, 99 employed subjects (mean age 45 years, 20–63), 61% white- and 39% blue-collar workers with acute LBP were examined within 48 h after the onset of pain. All patients were initially assessed using the Depression Anxiety and Positive Outlook Scale (DAPOS) and the Tampa Scale of Kinesiophobia (TSK) questionnaires. Thereafter, the patients documented the following in a diary over a 7-day period: pain intensity, disability rating index (DRI) and step count (pedometer). Linear Mixed Models (LMM) for repeated measures were employed for the statistical analyses. All results were adjusted for age, gender, treatment, number of days and for the interaction term (treatment *DAPOS-D). Results Prospectively, DRI and pain intensity responses were differentially mediated by the treatment, in interaction with the scores of DAPOS (p<0.05). Patients with high scores on DAPOS exhibited higher risk for worse pain-disability after follow-up. Additionally, patients with higher baseline scores on TSK (>38) had a lower step count over time (p<0.05). Conclusion Depressed mood and fear of movement affect the outcomes of disability, the level of physical activity and the pain intensity in patients with acute LBP.