Multisite adolescent pain as clinical marker of mental health disorder in youth

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Musculoskeletal pain at multiple sites among adolescents may be associated with an increased risk of mental health disorders, especially mood and anxiety disorders, and mental healthcare use in young adulthood, a study suggests.

The study included 3,987 students aged 15 to 16 years who participated in the Norwegian Arctic Adolescent Health Study (NAAHS) conducted from 2003 to 2005. Their medical records were linked to a registry that identified specialized healthcare usage when the participants were aged 18 to 20, to 23 to 25 years.

Based on the 5-year data, young adults who reported two or more musculoskeletal pain sites in adolescence had markedly greater mental healthcare use than did adults without any musculoskeletal pain site in adolescence. Anxiety and mood disorders were the prevalent mental health disorders in the population (5 and 4.1 percent, respectively). [BMJ Open 2017;7:e012035]

Mental healthcare use in young adulthood among individuals with multisite musculoskeletal pain in adolescence was significantly associated with the following adolescent factors: anxiety/depression symptoms (odds ratio [OR], 1.63; 95 percent CI, 1.29 to 2.07; p<0.001), school-related stress (OR, 1.07; 1.01 to 1.14; p=0.024), physical activity (OR, 0.79; 0.69 to 0.89; p<0.001) and family income (OR, 0.76; 0.65 to 0.90; p=0.001).

The finding of an attenuated association between multisite adolescent musculoskeletal pain and later mental health problems following adjustments for adolescent psychosocial and mental health problems may be attributed to confounding or mediating effects, “indicating an intertwined relationship between adolescent psychosocial problems and musculoskeletal pain in predicting mental health problems,” researchers said.

They also noted that adolescent mental health disorders in primary care has a low recognition rate, with short clinical consultations posing a challenge to discovering underlying mental health problems in patients presenting with physical symptoms.

“Therefore, physical symptoms, such as pain, should not be ignored in the early detection of mental health problems… Early detection might reduce the duration of illness and the splitting of physical and psychosocial problems.”

The study had several limitations, including the reliance on self-reports to gather the information required for the analysis, as well as the inability to identify whether the adolescent factors occurred prior to or after the adolescent musculoskeletal pain.