Chronic pain is common in Western societies. Self-rated health is an important indicator of morbidity and mortality, but little is known about the relation between chronic pain and self-rated health in the general population.
To analyze the association between chronic pain and self-rated health.
A questionnaire survey carried out during the spring of 2002 of an age- and sex-stratified population sample of 6500 individuals in Finland aged 15 to 74 years, with a response rate of 71% (N = 4542) after exclusion of those with unobtainable data (n = 38). Chronic pain was defined as pain with a duration of at least 3 months and was graded by frequency: (1) at most once a week; (2) several times a week; and (3) daily or continuously. On the basis of a 5-item questionnaire on self-rated health, individuals were classified as having good, moderate, or poor health. Multinominal logistic regression analysis was used to assess the determinants of health. Analysis included sex, age, education, working status, chronic diseases, and mood.
Perceived chronic pain graded by frequency and self-rated health status.
The prevalence of any chronic pain was 35.1%; that of daily chronic pain, 14.3%. The prevalence of moderate self-rated health was 26.6% and of poor health, 7.6%. For moderate self-rated health among individuals having chronic pain at most once a week compared with individuals having no chronic pain, the adjusted odds were 1.36 (95% confidence interval [CI], 1.05-1.76); several times a week, 2.41 (95% CI, 1.94-3.00); and daily, 3.69 (95% CI, 2.97-4.59). Odds for poor self-rated health were as follows: having chronic pain at most once a week, 1.16 (95% CI, 0.65-2.07); several times a week, 2.62 (95% CI, 1.76-3.90); and daily, 11.82 (95% CI, 8.67-16.10).
Chronic pain is independently related to low self-rated health in the general population.
Multimorbidity is prevalent, and knowledge regarding its aetiology is limited. The general pathogenic impact of adverse life experiences, comprising a wide-ranging typology, is well documented and coherent with the concept allostatic overload (the long-term impact of stress on human physiology) and the notion embodiment (the conversion of sociocultural and environmental influences into physiological characteristics). Less is known about the medical relevance of subtle distress or unease. The study aim was to prospectively explore the associations between existential unease (coined as a meta-term for the included items) and multimorbidity.
Our data are derived from an unselected Norwegian population, the Nord-Trøndelag Health Study, phases 2 (1995-1997) and 3 (2006-2008), with a mean of 11 years follow-up.
The analysis includes 20 365 individuals aged 20-59 years who participated in both phases and was classified without multimorbidity (with 0-1 disease) at baseline.
From HUNT2, we selected 11 items indicating 'unease' in the realms of self-esteem, well-being, sense of coherence and social relationships. Poisson regressions were used to generate relative risk (RR) of developing multimorbidity, according to the respondents' ease/unease profile.
A total of 6277 (30.8%) participants developed multimorbidity. They were older, more likely to be women, smokers and with lower education. 10 of the 11 'unease' items were significantly related to the development of multimorbidity. The items 'poor self-rated health' and 'feeling dissatisfied with life' exhibited the highest RR, 1.55 and 1.44, respectively (95% CI 1.44 to 1.66 and 1.21 to 1.71). The prevalence of multimorbidity increased with the number of 'unease' factors, from 26.7% for no factor to 49.2% for 6 or more.
In this prospective study, 'existential unease' was associated with the development of multimorbidity in a dose-response manner. The finding indicates that existential unease increases people's vulnerability to disease, concordant with current literature regarding increased allostatic load.
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To replicate previously reported associations between major depressive episodes (MDEs) and long-term medical conditions in a Canadian community sample.
A sample of 2542 household residents was selected using random digit dialing (RDD). Data were collected by telephone interview. The Composite International Diagnostic Interview (CIDI)-Short Form for major depression (CIDI-SFMD) was used to identify MDEs occurring in the previous 12 months. Long-term medical conditions were identified by self-report.
The prevalence of MDE was elevated in those subjects who reported 1 or more long-term medical conditions. The association was not due to confounding by age, sex, social support, or stressful recent life events.
This study replicates a previously reported association between depressive disorders and long-term medical conditions. These cross-sectional associations suggest that medical conditions may increase the risk of major depression or that major depression may increase the risk of medical conditions. Alternatively, comorbid medical conditions may influence the duration of depressive episodes, or vice versa. These explanations are not mutually exclusive.
Survival rates of children with a chronic illness is at an all-time high. Up to 98% of children suffering from a chronic illness, which may have been considered fatal in the past, now reach early adulthood. It is estimated that as many as 30% of school-aged children are affected by a chronic illness. For this population of children, the prevalence of educational and psychological problems is nearly double in comparison with the general population.
This study investigated the educational and psychological effects of childhood chronic illness among 1512 Canadian children (ages 10-15 years). This was a retrospective analysis using data from the National Longitudinal Survey of Children and Youth, taking a cross-sectional look at the relationships between childhood chronic illnesses, performance on a Mathematics Computation Exercise (MCE) and ratings on an Anxiety and Emotional Disorder (AED) scale.
When AED ratings and educational handicaps were controlled for, children identified with chronic illnesses still had weaker performance on the MCE. Chronic illness did not appear to have a relationship with children's AED ratings. The regression analysis indicated that community type and illness were the strongest predictors of MCE scores.
The core research implications of this study concern measurement issues that need to be addressed in future large-scale studies. Clinical implications of this research concern the need for co-ordinated services between the home, hospital and school settings so that services and programmes focus on the ecology of the child who is ill.
Department of Psychiatry and Behavioural Neurosciences, Offord Centre for Child Studies, McMaster University, Chedoke Site, Central Building, Room 310, 1280 Main Street West, Hamilton, Ontario, Canada, L8S 4K1. firstname.lastname@example.org
The objectives of this study were to determine whether a measure of global self-concept demonstrated longitudinal measurement invariance between adolescents aged 10-19 years with and without chronic illness and to document differences in their global self-concept trajectories over time.
Data were obtained from the National Longitudinal Survey of Children and Youth (N = 10,064). Global self-concept was measured using a scale based on the Self-Determination Questionnaire.
16 percent of adolescents had chronic illness. There was evidence of partial longitudinal invariance in global self-concept between adolescents with and without chronic illness. Controlling for sociodemographic characteristics, adolescents with a chronic illness exhibited lower levels of global self-concept and more precipitous declines over time.
The results from this study suggest that comparisons of global self-concept between adolescents with and without chronic illness are meaningful and, compared to healthy controls, adolescents with chronic illness are at risk for low global self-concept.
According to the Swedish Public Health Report of 1991, health has improved in the 45-64-year-old age group of the gainfully employed population during the 1980s. Cardiopulmonary and gastrointestinal diseases have become less common, whereas certain types of cancer, allergy, and locomotor pain are on the increase. The prevalence of locomotor pain among young working women has doubled. The number of those on early pensions is increasing, which may be due to increasing demands in the working environment as well as to organisational re-structuring. The report points out that the chronically ill and those on disability pensions are finding it harder to compete in the housing market. A medical class distinction is made: those with long-term mental illness have a much worse standard of living than those with somatic diseases.
This article compares the impact of various self-reported chronic conditions on health-related quality of life, as measured by the Health Utilities Index 3 (HUI3), for the population aged 12 or older.
The data are from the cross-sectional household component of the Health file of the 1996/97 National Population Health Survey.
The effect of 21 chronic conditions was assessed for the full sample (73,402) and in subgroups by age and sex. All analyses were weighted to represent the Canadian population at the time of the survey. The effect of each chronic condition on the HUI3 was estimated using multivariate linear regression, adjusting for age, sex and co-morbidity.
The average impact of different chronic conditions on health status varies substantially. At younger ages, urinary incontinence and arthritis/rheumatism have the greatest effect on health-related quality of life, while at older ages, Alzheimer's disease and the effects of stroke have a major impact. Assessments of the impact of any specific condition should account for the presence of other conditions.
To estimate (1) the prevalence of long-term medical conditions and of comorbid major depression, and (2) the associations between major depression and various chronic medical conditions in a general population of older adults (over 50 years of age) and in persons who are traditionally classified as seniors (65 years and older).
Data from the Canadian Community Health Survey- Mental Health and Wellbeing (CCHS-1.2) were analyzed. Non-institutionalized individuals over 15 years of age in the 10 Canadian provinces were sampled in the CCHS-1.2. The entire sample of the CCHS-1.2 consisted of 36,894 individuals, for the main analyses in this study the dataset was restricted to those aged 50 and over (n=15,591). Chronic health conditions were assessed using a self-report method of doctor diagnosis. The World Mental Health-Composite Diagnostic Interview was used to asses major depressive episodes based on DSM-IV criteria.
The overall prevalence of having at least one chronic condition in those over 50 years of age was 82.4%, compared to 62.0% in those under 50. The prevalence of a major depressive episode in those over 50 with one chronic condition was 3.7%, compared with 1.0% in those without a long-term medical condition. The top 3 chronic health conditions in seniors aged 65 or older were arthritis/rheumatism, high blood pressure and back problems. Chronic Fatigue Syndrome, fibromyalgia and migraine headache had the highest comorbidity with major depression in the senior population.
The use of self-report data on chronic health conditions, potential diagnostic overlap between conditions, and the inability to make causal inferences due to the cross-sectional nature of the data are all limitations of the current study.
Differences were found between rates of chronic conditions and major depression between the general population, older adults and seniors in this study. Further research is needed to delineate the direction of these relationships in seniors. Primary and secondary prevention efforts should target seniors who exhibit symptoms of depression or highly prevalent chronic health conditions.
Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands. email@example.com
J Gerontol B Psychol Sci Soc Sci. 2013 Sep;68(5):848-58
With age, there is an increasing gap between relatively stable levels of self-rated health (SRH) and actual health status. This study investigates longitudinal changes in SRH and examines its sensitivity to changes in chronic conditions and functioning among people aged 90 and older.
In the Vitality 90+ Study, questionnaires were sent to all people aged 90 years and older living in Tampere, Finland. Included were respondents who provided data on the 2001 measurement and at least one follow-up measurement in 2003, 2007, or 2010 (N = 334). Generalized Estimating Equations analyses examined longitudinal change in SRH and the predictive value of number of chronic conditions and a functioning score based on 5 activities.
Within 2 years, most people (56.3%) had unchanged SRH, but declined SRH (22.3%) was associated with worse baseline functioning and declined functioning. Clear declines in SRH after 6 and 9 years were associated with increased chronic conditions (odds ratio [OR] = 1.23) and decreased functioning (OR = 1.28). The impact of chronic conditions and functioning was smaller among institutionalized people (chronic conditions OR = 0.90; functioning OR = 1.18) than among people living independently (chronic conditions OR = 1.30; functioning OR = 1.44).
SRH among nonagenarians was sensitive to changes in the number of chronic conditions and functioning although more pronounced on the longer than on the shorter term.
Health related quality of life (HRQoL) is an important subjectively evaluated outcome of adolescents physical, mental, and social functioning. It gives us the possibility to assess the disease impact on life of adolescents, and to sort out target groups of adolescents for future psychological interventions. The objective of this cross-sectional survey was to study HRQoL in 173 adolescents with chronic physical illness (CPI - diabetes, asthma, and epilepsy), and to find HRQoL predictors in each disease group.
Disease-specific questionnaires were completed by each adolescent recruited from the local outpatient clinic; mothers answered the questions on socioeconomic status (SES); and the patients' clinicians evaluated the severity of the disease.
A high proportion of adolescents in each disease specific sample reported moderate to high levels of HRQoL. Gender was the most prominent predictor of HRQoL in all three studied groups, while disease severity predicted HRQoL in the diabetic group and to some extent in the asthma group.
Our results provide evidence that adolescents with diabetes, asthma, and epilepsy in northern Russia maintain relatively moderate to high levels of HRQoL. The domains affecting HRQoL were related to both disease-specific (severity) and non-disease factors (gender and SES). Our study suggests that future psychosocial interventions should focus on aspects of CPI impacting adolescents in gendered ways, furthermore taking into account disease specific factors.