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Association between musculoskeletal disorders and depressive symptoms across age groups and contribution of socioeconomic and behavioural factors: A population-based study Nearkasen Chau , PhD 1 , Slimane Belbraouet , PhD 2 , Carmen Otero Sierra, PhD, MD 3 , Lorhandicap group 1.

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1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012

Association between musculoskeletal disorders and depressive symptoms across age groups and contribution of socioeconomic and behavioural factors: A population-based studyNearkasenChau, PhD1, SlimaneBelbraouet, PhD2, Carmen Otero Sierra, PhD, MD3, Lorhandicap group1

1INSERM, U669, University Paris-Sud, University Paris Descartes, UMR-S0669, Paris, France.

2Human Nutrition Program, Department of health sciences, College of Arts and sciences, Qatar university; Ecole de Nutrition, University of Moncton, Canada;

3CERpIEResearch Centre for Corporate Excellence & Innovation, UPC UniversitatPolitècnicade Catalunya, Av. Diagonal, 647 planta 10, ETSEIB, 08028 Barcelona, Spain;

background and objectives
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Background and objectives
  • Mental disorders are common:
    • 450 millions people worldwide (Hosman et al., WHO report 2004)
    • 83 millions adults (18-65 yr, 27%) in European Union

(Wittchen & Jacob, EurNeuropharmacol2005)

    • Depressive symptoms affect 23% of men and 31% of women (12-75 yr) in France (Beck et al., Paris: INPES, 2007)
    • Theyrepresent10% of total health care expediture, with direct & indirect costshigherthan cancer and diabetes(FondationFondamental2011)
  • Depressive symptoms (DPS) relate to unhealthy behaviours and disability, and may become the most frequent cause of disability worldwide

(Penninx et al., ArchgenPsychiatry 1999; Khlat et al., Scand J Public Health 2010 ; WHO 2010;

Chau et al., J OccupEnvionMed 2011)

background and objectives1
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Background and objectives
  • Musculoskeletal disorders (MSD) are common:
    • Most cause of work absence and disability worldwide (Euller-Ziegler, J RheumatolSuppl 2003; Roquelaureet al., Arthritis & Rheumatism 2006)
    • Two-thirds of occupational diseases in France (2003)

(Roquelaure et al., Arthritis & Rheumatism 2006)

    • Social disparities in MSD and associated DPS (Khlatet al., Scand J Public Health2010)
  • Severalageperiodsmaybedistinguished:
    • Young adults (18-29 yr) with generally less good work conditions and higher risk for psychosomatic and mental disorders (Chau et al., Int J Equity Health 2008; Legleye et al., J Affect Disorders 2010)
    • From 45-50 yr to retirement: disabilitiesappearwhile people are working
    • From 60-65 yr: after retirement working performance is not needed.
  • There are marked gender/age disparities in MSD, DPS, psychosomatic disorders, health behaviours (Baumann et al., Int J Health Geogr2007; Chau et al., Occup Med (London) 2009).
background and objectives2
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Background and objectives

Socioeconomiccontext of the study population:

  • The Lorraine region (2.3 millions inhabitants), in the North-East, was one of the leadingindustrialregionsin France following the second war.
  • It has been particularly exposed to labour market hardship during the past decades because of massive desindustrialisation and tertiarisationduring the last 50 years.

Objectives:

To assess in the Lorraine region:

  • The association between musculoskeletal disorders and depressivesymptomsamongmen and womenacrossage groups.
  • The contributions of
    • Socioeconomic factors: education, living alone, occupation, and income
    • and tobacco smoking, alcohol abuse, and obesity
methods
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Methods
  • The sample included subjects aged 15+ years living in 1996 in 8,000 randomly selected households in the Lorraine region (1/100 of the population).
  • Study protocol : an application to participate and 3sendings of self-administered questionnaires at 1-month intervals
    • 3,460 householdsparticipated(44%), in 86% of them alleligible members took part
    • 6,234 subjects filled in a questionnaire, 34 with unknown gender or age
    • 6,200 subjects (2,951 men and 3,249 women)
    • The investigation was approved by the national review board (CNIL).
  • Written informed consent from respondents.
methods1
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Methods

Depressive symptoms (Duke questionnaire, over the past week): 5-item scale

(Parkersonet al., Med Care 1990; Guillemin et al., SantePublique 1997).

  • Giving up too easily,
  • Difficulty concentrating,
  • Sleeping disorders,
  • Tiredness,
  • Feeling depressed or sad.

The scale was one-dimensional: factor analysis yielded the first eigenvalue of 1.32 much higher than the 2nd eigenvalue of 0.23

Cronbach alpha coefficient was satisfactory: 0.65

Score defined as the sum of items, range: 0 to 10 (best value)

Cutoff value used: score 5 or over (giving similar prevalence in the literature)

c ovariates
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Covariates
  • Socioeconomicfactors:
  • sex,
  • age,
  • education,
  • living alone,
  • Occupation (former occupation for retired and inactive people):
  • Manager, head of firm, and professional
  • Craftsman, tradesman, intermediateprofessional
  • Clerk
  • Manualworker
  • Others
  • Insufficient income (coping with difficulties or getting into debt vs. comfortable, well off or earning just enough).
covariates
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Covariates
  • Tobacco smoking habit
  • Non smoker, currentsmoker, former smoker
  • Alcohol abuse:
  • withCut/Annoyed/Guilty/Eye-opener (CAGE) questionnaire(Beresford et al., Lancet 1990)
  • At least 2positive responses to four items:
  • Consumption considered excessive by the subject,
  • Consumption considered excessive by people around the subject,
  • Subject wishes to reduce consumption,
  • Consumption on waking.
  • Obesity
  • Computedwith self-reportedheight and weight, > 30 kg/m2
statistical analysis
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Statisticalanalysis

Associations of DPS or MSD with covariates: analyzed with logistic regression models which yield odds ratios (OR)

Associations between DPS and MSD, and contribution of covariates: analyzed with logistic regression models

─ Model 0: Crude OR

─ Model 1: adjusted for education, living alone, occupation, and income

─ Model 2: Model 1 + smoking, alcohol abuse and obesity

Contribution of covariates (%) = Reduction in OR computed with the following formula: (Crude OR – ORmodel j)/(Crude OR – 1) ; j = 1 or 2.

STATA software (Stata, College Station, TX, USA) was used.

results
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Results

Table 1. Characteristics of subjects: %

results3
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Results

Table 2. Associations between depressive symptoms and covariates according to age

in men: crude odds ratio

results4
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Results

Table 3. Associations between musculoskeletal disorders and covariates according to age

in men: crude odds ratio

results5
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Results

Table 4. Associations between depressive symptoms and covariates according to age

in women: crude odds ratio

results6
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Results

Table 5. Associations between musculoskeletal disorders and covariates according to age

in women: crude odds ratio

results7
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Results

Table 7. Associations between depressive symptoms and musculoskeletal disorders

(both sexes combined): odds ratio (OR) and 95% CI

results8
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Results

Table 8. Associations between depressive symptoms and musculoskeletal disorders

in men: odds ratio (OR) and 95% CI

results9
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Results

Table 9. Associations between depressive symptoms and musculoskeletal disorders

in women: odds ratio (OR) and 95% CI

conclusions
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Conclusions
  • Prevalence of MSD and DPS:
    • Prevalence of MSD steadily increase with age from about 30% to about 85% for men and women
    • Prevalence of DPS slightly higher after 35 years for men and women
    • DPS risk associated with MSD across age groups:

Higher risk for <25 yr and after 45 yr for men and women

conclusions1
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Conclusions
  • Covariates for DPS:
    • Primary school for 45-54 yr in men ─ 35-44 and 45-54 yr in women
    • Insufficient income for <55 yr in men ─ nearly all age groups in women
    • Smoking for <25 yr, alcohol abuse for most age groups in men and women
    • Obesity for 45-54 yr in women
    • Manual worker for from 45 yr to retirement in men
    • Service workers/clerks and manual worker for nearly all age groups in women
    • Covariates for MSD:
    • Low education (<university) for most age group after 25 yrin men ─ 35-44 yrin women
    • Insufficient income for 35-54 yr in men ─ 25 to 54 yr in women
    • Smoking for 25-34 yr in women
    • Alcohol abuse for <44 yr in men
    • Obesity for 25-34 yr in men
    • Most occupations for 35-54 yr (all ages for manualworkers) inmen
    • Service workers/clerks and manual worker after retirement in women
conclusions2
1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012Conclusions

Association between DPS and MSD:

Men:

  • Higher after 45 yr
  • Higher contribution of covariates for ≤24 yr (about 20%) and for 45-54 yr (about 33%)
  • Small contribution of covariates (<14%) for other age groups

Women:

  • Higher after 45 yr
  • Small contribution of covariates for 35-44 and 45-54 yr(11-12%)
  • Smaller contribution of covariates (≤8%) for other age groups

Prevention for DPS associated with MSD should consider subject’s age and socioeconomic and behavioural characteristics

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