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  • 1.
    Jansen, Gunilla Brodda
    et al.
    Department of Pain Management, Capio St Göran's Hospital.
    Linder, Jürgen
    Karolinska Institutet, Sweden.
    Ekholm, Kristina Schüldt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Ekholm, Jan
    Karolinska Institutet, Danderyd Hospital.
    Differences in symptoms, functioning, and quality of life between women on long-term sick-leave with musculoskeletal pain with and without concomitant depression.2011In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 4, p. 281-292Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim was to describe the differences in symptoms, functioning and quality of life between women on long-term sick-leave due to protracted musculoskeletal pain with and without concomitant depression.

    DESIGN: Descriptive and comparisons with/without comorbid depression.

    METHODS: 332 female patients were examined by three specialist physicians in psychiatry, orthopedic surgery, and rehabilitation medicine and assigned to four groups according to the ICD-10 diagnoses: low back/joint disorders (LBJ, n = 150), myalgia (M, n = 43), fibromyalgia (FM, n = 87), or depression without somatic pain diagnosis (DE, n = 52).

    RESULTS: Patients with somatic pain conditions LBJ, M, or FM showed more activity-related difficulties if concomitant depression was present during the activities 'focusing attention', 'making decisions', and 'undertaking a single task'; and in the domains 'energy level', 'memory functions', 'emotional functions', and 'optimism/pessimism'. Patients with FM and concomitant depression perceived higher pain intensity than patients in group DE. No statistically significant differences in physically related activities were noted between each of the somatic pain conditions with and without coexisting depression. FM patients with coexisting depression reported fewer painful sites on their pain drawings compared with FM-patients without depression. Patients with LBJ or FM and concomitant depression reported lower quality of life in the dimensions vitality, social functioning, emotional role, and mental health. Comorbid depression affected disability and restricted working capacity by reducing mental activity and functioning but not by affecting physical activity problems.

    CONCLUSION: Women on long-term sick-leave, who have concomitant depression with LBJ or FM, also have more difficulties in focusing attention, making decisions, and carrying out tasks, and with memory functions and optimism/pessimism, as well as reduced quality of life in the dimensions of vitality, social functioning, emotional role, and mental health, than female patients without comorbid depression. As a consequence we suggest further efforts to integrate somatic and psychiatric interventions in the same rehabilitation program.

  • 2.
    Linder, J
    et al.
    Karolinska Institutet.
    Ekholm, Kristina Schüldt
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences. Karolinska Institutet; Danderyds Sjukhus.
    Lundh, G
    Karolinska Institutet.
    Ekholm, J
    Karolinska Institutet; Danderyds Sjukhus.
    Long-term sick-leavers with fibromyalgia: Comparing their multidisciplinarily assessed characteristics with those  of others with chronic pain conditions and depression2009In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 2, p. 23-37Article in journal (Refereed)
    Abstract [en]

    Objective: The aim was to gain knowledge of fibromyalgia (FM) patients on long-term sick leave and with particular difficulties in resuming work, and to compare them with patients with myalgia, back or joint diagnoses, and depression.

    Methods: Patients were identified by and referred from social insurance offices and were multidisciplinarily examined by three board-certified specialists in psychiatry, orthopedic surgery and rehabilitation medicine. Ninety-two women were diagnosed with FM only. Three female comparison groups were chosen: depression, back/joint diagnoses, and myalgia.

    Results and conclusions: Ceaseless pain was reported by 73% of FM patients, 54% of back/joint diagnoses patients, 43% of myalgia patients, and 35% of depression patients. The distribution of pain (>50%) in FM patients was to almost all regions of the body, and in depression patients to the lower dorsal neck, upper shoulders and lumbosacral back but not in the anterior body. Reduced sleep was more evident in FM patients. FM patients did not meet more criteria for personality disorder than patients with the other somatic pain conditions. The most common dimension of “personality traits” of somatic pain conditions was the “obsessive compulsive” but at a level clearly below that indicating a personality disorder. More FM patients experienced disabilities, the most common being in the mobility and domestic-life areas.

  • 3.
    Sjöström, Rita
    et al.
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Asplund, Ragnar
    The Research and Development Unit, Jämtland County Council, Östersund, Sweden.
    Alricsson, Marie
    Mid Sweden University, Faculty of Human Sciences, Department of Health Sciences.
    Back to work: evaluation of a multidisciplinary rehabilitation program with emphasis on mental symptoms; A two-year follow up2012In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 5, p. 145-151Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this investigation was to analyze temporal changes in anxiety, depression, and stress in patients with musculoskeletal pain for a period of up to 2 years after a multidisciplinary rehabilitation program, in relation to sick-listing (registered with The Swedish Social Insurance Agency [Forsakringskassan] for sickness benefit). Methods: Ten persons with full-time sick leave (absence from work for medical reasons) (group 1) and 49 with part-time or no sick leave (group 2) at the end of the 2-year study period participated. It was shown in a previous study that group 1 had higher pain rating and higher subjective physical disability than group 2, with little or no improvement during and after rehabilitation. In the present study, all participants were evaluated with the Hospital Anxiety and Depression scale and a self-rated stress test. Results: Participants with full-time sick leave during the study period (group 1) showed improved stress levels but no change in anxiety and depression levels. Anxiety, depression, and stress changed more favorably in participants with part-time or no sick leave than in those with full-time sick leave. Conclusion: The results of this study indicate that investigation and appropriate treatment of psychological symptoms, including anxiety and depression, are important in multidisciplinary rehabilitation of patients with musculoskeletal disorders

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