when musculoskeletal conditions and mental disorders occur

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80Bulletin 80 • September 2010

When musculoskeletal conditions and mental disorders occur together

Summary• Musculoskeletalconditionsandmentaldisorderscausefewdeathsbutmuchpain,

disabilityanddistress.Botharecommonandarerecognisedasmajorhealthconcerns.Theiroccurrencetogetherinthesameperson(knownascomorbidity)complicatestheirtreatmentandmanagement.

• Thisbulletinpresentsthemostreliable,robustandup-to-dateestimatesofthenumberofpeoplewithbothmusculoskeletalconditionsandmentaldisorders;estimatesthatareimportantinassessingtheneedforintegratedcare.

• Morethan6.1millionAustraliansaged16–85yearssufferfromamusculoskeletalconditionatapointintime(38%ofthatpopulation)and3.2million(20%)experienceamentaldisorderina12-monthperiod.

ContentsSummary .................................................................................................................................................................................................... 1Introduction ............................................................................................................................................................................................... 2The nature of musculoskeletal conditions .................................................................................................................................................. 3The nature of mental disorders .................................................................................................................................................................. 5Comorbidity—its causes and consequences ............................................................................................................................................. 7Prevalence of comorbidity .......................................................................................................................................................................... 8Observed and expected prevalence of comorbidity ................................................................................................................................. 10Comorbidity among people with musculoskeletal conditions ................................................................................................................. 10Comorbidity among people with mental disorders ..................................................................................................................................11Types of mental disorders in people with musculoskeletal conditions .....................................................................................................12Conclusion .................................................................................................................................................................................................14Acknowledgments ....................................................................................................................................................................................14References .................................................................................................................................................................................................15Appendix: Statistical table and methods ................................................................................................................................................. 16

(summary continued overleaf)

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• Over1.5millionpeople(10%ofAustraliansaged16–85years)hadatleastonemusculoskeletalconditionandonementaldisorderinthepreceding12months.Thenumberoffemalesexperiencingthiscomorbidity(862,000)wasgreaterthanthenumberofmales(671,000).Theextentofcomorbidityincreasedsharplyineachsuccessiveagegroupuntil45–54years,afterwhichitdecreasedsharply.

• Therewere470,000moreAustralianswhohadbothamusculoskeletalconditionandamentaldisorderin2007thanwouldbeexpectedifoccurrencesofthetwoconditionswereindependentofoneanother.

• Publishedstudiessuggestthatcausalpathwaysaremorelikelytobefrommusculoskeletalconditionstomentaldisordersthanthereverse,althoughthelattercanalsooccur.Overall,in2007,25%ofpeoplewithamusculoskeletalconditionalsohadamentaldisorder,themostcommonofwhichwereanxietydisorders.

• Theclearassociationbetweenmusculoskeletalconditionsandmentaldisordersfoundinthisstudyemphasisestheneedforhealth-careproviderstobeawareofandprovideforamultidisciplinaryapproachtothemanagementofthiscomorbidity.

Introduction

Musculoskeletalconditionsandmentaldisorderscanbebothsevereandpersistentillnesses,contributingsignificantlytolevelsofillhealth.Musculoskeletalconditions,whichincludearthritis,osteoporosisandbackpain,resultinfewdeathsbutcausesignificantpainanddisability.Theyseverelylimitaperson’sabilitytoperformeverydaytasksathomeandatwork(AIHW2008).Mentaldisordersincludethecommondisordersofanxietyanddepression,aswellaslesscommonorlow-prevalencedisorders,suchasschizophrenia.Althoughfewerdeathsareattributedtomentaldisorders(otherthantheirhighassociationwithsuicide)thanotherleadinghealthproblems,theyarethecauseofmuchdistressanddisabilityinthepopulation(AIHW2010).

Theoccurrencetogetherofmusculoskeletalconditionsandmentaldisordersinthesameperson,knownascomorbidity,oftencomplicatestreatmentandmanagementplans.Whilesomeissuesremainspecifictoeachconditionordisorder,thestandardtreatmentofmentaldisordersmayneedtobemodifiedinviewofthephysicalchangesassociatedwithamusculoskeletalconditionorwiththemedicationusedforitstreatment.Similarly,themanagementofmusculoskeletalconditionsmayneedtobemodifiedinthepresenceofamentaldisorder.

Sincetheclinicalmanagementofpeoplewithcomorbidconditionscanbemorecomplexandtimeconsumingthanforthosewithsingleconditions,informationabouttheprevalenceofcomorbidityshouldhelpassesstheneedformoreintegratedcare.ThisbulletindocumentsthecomorbidityofmusculoskeletalconditionsandmentaldisordersinAustraliawiththataiminmind.



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The nature of musculoskeletal conditions

Musculoskeletalconditionsarecommonandvaried.Theyarecharacterisedbyhighprevalence,generallylateageofonset,longdurationandlowfatality.Theyarealsosignificantcontributorstophysicaldisability.

Therearemorethan200formsofmusculoskeletalconditions,includingvarioustypesofarthritis,whichaffectthejoints,bones,musclesandtheirattachmentstoeachother.Theirsymptomsandproblemsmayarisefromtheoveruseofjoints,congenitalanomalies,metabolicorbiochemicalabnormalities,infections,inflammation,traumaandcancer.

Themostcommonlyoccurringmusculoskeletalconditionsarebackpainandvariousformsofarthritis.Otherwell-knownconditionsincludeosteoporosis,slippeddisk,gout,systemiclupuserythmatosus(SLEorlupus),‘frozenshoulder’andscoliosis.AbriefdescriptionofsomecommonmusculoskeletalconditionsisgiveninBox1.

Box 1: Common musculoskeletal conditionsArthritis A group of conditions involving inflammation of the joints, causing

pain, stiffness, deformity and disability. More than 100 different forms of arthritis are recognised, prominent among which are osteoarthritis, rheumatoid arthritis and gout.

Osteoarthritis The most common form of arthritis, caused mainly by the accumulated wear of the cartilage in joints. This wear and tear disrupts the normal function of the joint, causing pain and functional limitations. The condition affects mainly the hands, spine, and weight-bearing joints, such as the hips, knees and ankles.

Rheumatoid arthritis A chronic, inflammatory, autoimmune disease in which the immune system attacks the tissues lining the joints. The inflamed joints often cause pain, heat and swelling, and can lead to functional limitations and severe disability.

Gout Gout is characterised by painful swelling in various joints, in particular the great toe. The condition, resulting from poor handling of uric acid by the body, affects the entire body but manifests chiefly in joints.

Back pain Pain coming from the spine, muscles, nerves or other structures in the back. It mostly arises as a direct result of disease or injury involving spinal tissues. However, the pain arising from disease or injury of tissues and organs outside the spine can also be perceived as coming from the back (referred pain).

Osteoporosis A condition where the bone density thins and weakens, resulting in an increased risk of fracture—sometimes described as ‘porous bones’. Osteoporotic fractures are common among the elderly, with the spine, hip and wrist being common sites.


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Symptoms and complications

Akeysymptominmusculoskeletalconditionsispain(acuteorchronic).Acutepainlastsafewsecondsorlongerbutwanesashealingoccurs.Chronicpain,ontheotherhand,suchasthatseeninpeoplewitharthritisandbackpain,rangesfrommildtosevere,andcanlastweeks,months,years,oralifetime.Thepainmayoriginatefromdifferentsources,suchasinflammationofthetissuethatlinesthejoints,thetendonsandtheligaments,musclestrainandfatigue.Acombinationofthesefactorsmaycontributetotheintensityofthepain.Anothercommonpresentationofmusculoskeletalconditionsisstiffness,occurringmorecommonlywithrheumatoidarthritis.

Musculoskeletalconditionscanaffectvariousorgansofthebodyandcanleadtoavarietyofnon-musculoskeletalcomplications.Poorhealthoutcomes,suchasosteoporoticfractures,deformitiesandinabilitytomovearound,canaddtothephysicallimitations.

Age of onset

Theageofonsetofmusculoskeletalconditionsrangesfromchildhoodtooldage,dependingonthespecificcondition.Whiletheonsetofjuvenilearthritisisbydefinitionlimitedtopersonsyoungerthan16years,osteoarthritisandosteoporosismostlybegininolderadults.Rheumatoidarthritisontheotherhandtendstodevelopusuallyaroundages25to45years,whilemostcasesofosteoporosiscommenceatages45yearsandover.

Prevalence

Over38%(6.1million)Australiansaged16–85yearshaveamusculoskeletalcondition.Prevalenceisloweratyoungeragesandincreasessteadilyinolderages.Overallprevalenceishigheramongfemalesthanmalesineachagegroup(Figure1).

Source: AIHW analysis of ABS 2007 Survey of Mental Health and Wellbeing CURF.

Figure 1: Prevalence of musculoskeletal conditions, by age and sex, 2007

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30

40

50

60

70

80

16–24 25–34 35–44 45–54 55–64 65–74 75–85

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Age group (years)

Males

Females




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Differentgroupsofmusculoskeletalconditionshavequitedifferentagedistributions,reflectingdifferencesintheirageofonset,variationinincidenceandtheirrelativelylowdeathrates.Whilebackpainanddiscdisordersarecommonamongyoungadultsandcontinuetoremainprominentthroughmid-life,osteoarthritisisthemajormusculoskeletalconditionintheolderagegroups.Osteoporosisismostprominentinages55yearsandover.

Inviewoftheirdifferingagedistributionsandprevalence,aswellasavailabledata,musculoskeletalconditionsarebroadlygroupedintotwocategoriesforthisreport,asfollows:

• arthritis,rheumatismandgout

• backandneckproblems.

The nature of mental disorders

Mentaldisordersaffecttheperceptions,emotions,behavioursandresultingwellbeingofindividuals.Thereareseveraltypesofmentaldisorderswithvaryingdegreesofseverity.Useoftheterm‘mentaldisorder’impliestheexistenceofaclinicallyrecognisablesetofsymptomsorbehaviours,associatedinmostcaseswithdistressandinterferencewithpersonalfunctions(WHO1992).Mentaldisordersoftenrequiretreatment,includinghospitalisation,toalleviatethesymptomsandforrehabilitation(AIHW1998).

Major types of mental disorders

SomeofthemajortypesofmentaldisordersinAustraliaareanxietydisorders,depression,schizophreniaandsubstance-usedisorders.ThesearedescribedinBox2.Themorecommontypesofmentaldisorders,namelyanxiety,affectiveandsubstance-usedisorders,wereincludedinthe2007AustralianBureauofStatistics(ABS)NationalSurveyofMentalHealthandWellbeingandarethuscoveredinthisreport.

Box 2: Major types of mental disordersAnxiety disorders, characterised by symptoms of anxiety, fear and avoidance behaviour, include panic disorders, phobias, obsessive–compulsive disorder and post-traumatic stress disorder. Anxiety disorders have a lifetime adult prevalence rate of more than 26% in Australia (ABS 2008).Depression is a mood disorder characterised by feelings of sadness, loss of interest or pleasure in nearly all activities, feelings of hopelessness and suicidal thoughts or self-blame. It is one of the most common mental disorders in the community. Depression, along with dysthymia (a mild form of depression) and bipolar affective disorder, collectively referred to as affective disorders, have a lifetime adult prevalence rate of 15% in Australia (ABS 2008). Substance-use disorders result from harmful use or dependence on drugs and/or alcohol. Their lifetime prevalence rate in Australian adults is around 25% (ABS 2008).Schizophrenia is a group of severe psychiatric disorders that are characterised by major disturbances in thought, emotion and behaviour. The symptoms may include delusions, hallucinations, and disorganised thoughts and behaviours. Schizophrenia usually starts in late adolescence or early adult life, and occurs in less than 1% of the adult population.


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Age of onset

Manymentaldisordersbegininchildhoodoradolescence,withapproximatelyhalfofallmentaldisordersstartinginmid-teensandthree-quartersbythemid-20s(Kessleretal.2007;Scottetal.2008).Certainanxietyandaffectivedisordershavetheearliestageofonset.Themedianageofonsetofsomeanxietydisordersis7–11years;foraffectivedisordersitisabitlaterinadulthood.Substance-usedisordersoftenstartinearlyadulthood(18–29years).

Earlyageofonsetofmentaldisordersisoftenassociatedwithgreaterseverity,persistenceandlackoftreatmentresponse(Kessler&Wang2008).

Prevalence

Twentypercent(3.2million)ofAustraliansaged16–85yearshavementaldisorders,withtheirprevalencehigheramongfemalesthanmalesateachagegroup(Figure2).Unliketheagedistributionobservedformusculoskeletalconditions,whereprevalenceincreaseswithage,theprevalenceofmentaldisordersdecreaseswithage.Thepatternandsymptomsofmentaldisordersdifferbetweenthesexes.Whileanxietydisordersandaffectivedisorders,includingdepression,aremorecommoninfemales,substance-usedisordersoccurmorecommonlyamongmales(Klose&Jacobi2004).


Figure 2: Prevalence of mental disorders, by age and sex, 2007

0

10

20

30

40

16–24 25–34 35–44 45–54 55–64 65–74 75–85

Per cent

Age group (years)

Males

Females




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Comorbidity—its causes and consequences

What is comorbidity?

Comorbidityoccurswhenapersonhastwoormorehealthconditionsatthesametime.Inthisreport,comorbidityreferstothepresenceofanymusculoskeletalconditionwithoneormorementaldisorders.

Causes of comorbidity

Thesimultaneousoccurrenceofheathconditionscanhappenbychancealone.Someconditionscancoexistinonepersonbycoincidence,withoutanycausalrelationshipbetweenthem.However,oftenhealthconditionsoccurtogetherbecauseofsomedirectorindirectcausalrelationshipsbetweenthem.

Thereisagrowingrecognitionthatfunctionallimitationsandchronicpainassociatedwithmusculoskeletalconditionspredisposepeopletoavarietyofmentalhealthproblems.Long-termfunctionallimitationsandactivityrestrictionsmaycontributetoanxiety,depressionandfeelingsofhelplessness.Chronicpaincanfurtheraddtoirritability,insomniaandexhaustion,oftenaccompaniedbywithdrawalfromworkandsocialactivities.Thesefactorstogethermayalsoleadtosubstanceabuseandothersocio-behaviouralproblems.

Whilethefunctionallimitationsandpainaspectsofmusculoskeletalconditionscouldbeasignificantcontributoryfactorinthedevelopmentorexacerbationofmentalproblems,thereisgrowingevidencethatmentaldisorderscanalsohaveadeleteriouseffectonphysicalillness,painanddisability(Moussavietal.2007).Thepathwaysareproposedtobethroughtheimmune,endocrineandnervoussystems,alongwithbehaviouralriskfactors,suchaspoordiet,lackofphysicalactivityandsubstanceuse.

The evidence so far

Mostoftheclinicalandcommunitystudiesthathaveshowncrediblerelationshipsbetweenmusculoskeletalconditionsandmentaldisordershavebeenbetweenspecificconditionsanddisorders,suchasarthritisanddepression.Arthritis,inparticularrheumatoidarthritis,hasbeenreportedtobeassociatedwithmoodandanxietydisorders(Dickensetal.2002;Krishnanetal.2002;Sareenetal.2006).Studiesofchronicbackorneckpainhavealsobeenshowntobeassociatedwithdepression(Carrolletal.2004;Currie&Wang2004).Mostofthereportedassociationsarestrongerinparticularagesegments,suchasyoungpeopleorolderpersons(Keefeetal.2002;LeBovidgeetal.2003),andnotacrossthefullagespectrum.Limitedornoassociationhasbeennotedbetweenarthritisandsubstance-usedisorders(Brownetal.1996;Heetal.2008;Shihetal.2006).

Nobroad-levelpopulation-basedstudiesofcomorbiditybetweenthemusculoskeletalconditionsandmentaldisordershavepreviouslybeenreportedinAustralia.Thispossiblyreflectsconcernthatanystudyofassociationatthislevelofassessmentwouldhavelimited


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publichealthrelevancebecauseofthelimitedoverlapbetweentheagesofonsetofthetwosetsofconditionsandtheirverydifferentlifecourses.Whilemostofthementalhealthproblemsanddisordersariseearlyinlifebuthavelowprevalenceinolderagegroups,thebulkofmusculoskeletalconditionsarisesandpersistsinolderagegroups.Thismakescomorbiditydifficulttoquantifythroughcommunity-basedpopulationsurveysalone.

This report

ThereportexaminesthecurrentextentofcomorbidityinAustraliabetweenmusculoskeletalconditionsandmentaldisorders.Estimatesarepresentedbyagegroup,andformalesandfemalesseparately.Theobservedprevalenceratesofcomorbidityarecomparedwiththosethatmightbeexpectedtooccurpurelybychancealone.

TheestimatesinthisreportarederivedfromtheConfidentialisedUnitRecordFile(CURF)oftheNationalSurveyofMentalHealthandWellbeingconductedbytheABSfromAugusttoDecember2007.Thesurveycollectedinformationfromapproximately8,800Australiansaged16–85years.

Unlessotherwisestated,theprevalenceofpeoplewithmusculoskeletalconditionsrelatestothosewithalong-termconditionatthetimeofthesurvey,andprevalenceofpeoplewithmentaldisordersrelatestothe12-monthperiodpriortotheinterview.

Prevalence of comorbidity

During2007,over1.5millionpeople(10%ofthepopulationaged16–85years)hadatleastonemusculoskeletalconditionlongtermandatleastonementaldisorderintheprevious12months(Figure3andTableA1).Thenumberoffemalesexperiencingthiscomorbidity(862,000)wasgreaterthanthenumberofmales(671,000).

Note: The estimates are for people aged 16–85 years.Source: AIHW analysis of ABS 2007 Survey of Mental Health and Wellbeing CURF.

Figure 3: People with musculoskeletal conditions, mental disorders and their comorbidity, by sex, 2007

0

2,000

4,000

6,000

8,000

10,000

2,114

671 731

Males

2,497

862

934

Females

4,610

1,534

1,664

Persons

Number (’000)

Mental disorders without musculoskeletal conditions

Comorbidity

Musculoskeletal conditions without mental disorders




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Theage-specificprevalencerateofcomorbidityincreasedsharplyineachsuccessiveagegroupuntil45–54years,afterwhichitdecreasedsharply.Ratesweregenerallyhigherinfemalesthaninmalesbutthepatternsovertheentireagerangeweresimilar(Figure4).


Figure 4: Age-specific prevalence rates of comorbidity between musculoskeletal conditions and mental disorders, by sex, 2007

ThereasonforthispatternisshowninFigure5.Theprevalenceofmusculoskeletalconditionsislowerintheyoungeragegroupsandgreaterintheolderagegroups,whilethereverseistrueformentaldisorders.Theprevalenceofcomorbidityreflectstheincreasingprevalenceofmusculoskeletalconditionsinyoungeragegroupsandthedecreasing(andlower)prevalenceofmentaldisordersinolderagegroups.


Figure 5: Age-specific prevalence rates of musculoskeletal conditions, mental disorders and their comorbidity, 2007

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16–24 25–34 35–44 45–54 55–64 65–74 75–85

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Persons Males Females

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Per cent

Age Age group (years)

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70 Musculoskeletal conditions (includes comorbidity) Mental disorders (includes comorbidity) Observed comorbidity Expected comorbidity


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Observed and expected prevalence of comorbidity

Musculoskeletalconditionsandmentaldisordersmayoccurtogetherbychance.Undertheassumptionthattheoccurrenceofmusculoskeletalconditionsandmentaldisordersareindependent,theexpectedcomorbidityrateisestimatedbymultiplyingthetwoobservedprevalenceratestogether.Forexample,inTable1,theobservedprevalenceratesformusculoskeletalconditionsandmentaldisordersforages16–24yearsare12.4%and26.4%respectively.Multiplyingthesetogethergivesanexpectedcomorbidityrateof3.3%.Thiscompareswithanobservedrateof6.1%,adifferenceof2.8%,whichisequivalentto72,000people(2.8%of2,545,000,seeTableA1).Thedifferencebetweentheobservedandexpectednumbersofpeoplewithbothmusculoskeletalconditionsandmentaldisordersislabelled‘excesscomorbidity’inTable1.Thiscalculationwasperformedforeachagegroupandsummedacrosstheagegroups.

In2007,theobservedcomorbiditybetweenmusculoskeletalconditionsandmentaldisorderswasgreaterthanthatexpectedateachagegroupandtotalled470,000peopleoverall(Table1).Thehigherthanexpectedcomorbiditysuggestsanassociationbetweenthetwoconditions.

Table 1: Observed and expected comorbidity, musculoskeletal conditions and mental disorders

Age groupMusculoskeletal

conditionsMental

disordersObserved

comorbidityExpected

comorbidityExcess

comorbidity

Rate (per cent) Number

16–24 12.4 26.4 6.1 3.3 72,000

25–34 22.2 24.8 8.5 5.5 85,000

35–44 34.1 23.3 11.8 8.0 117,000

45–54 47.3 21.5 14.3 10.2 119,000

55–64 55.4 13.6 9.7 7.6 49,000

65–74 62.5 8.6 6.4 5.4 15,000

75–85 64.1 5.9 5.2 3.8 13,000

Total 38.4 20.0 9.6 7.7 470,000

Note: See Table A1 for population numbers. Excess comorbidity is estimated as the observed comorbidity rate x population – expected comorbidity rate x population for each age group. The total is the sum of the age-specific estimates.


Comorbidity among people with musculoskeletal conditions

Figure6showsthenumberofpeoplewithmusculoskeletalconditions,partitionedintothosewithmentaldisordersandthosewithout.Atages16–24years,almostone-half(49%)ofpeoplewithamusculoskeletalconditionalsohadamentaldisorder.Thisproportiondecreasedto8%intheoldestagegroup.Overall,25%ofpeoplewithamusculoskeletalconditionhadamentaldisorder.




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Figure 6: Presence of mental disorders in people with musculoskeletal conditions, 2007

Comorbidity among people with mental disorders

Figure7showsthenumberofpeoplewithmentaldisorders,partitionedintothosewithmusculoskeletalconditionsandthosewithoutthem.Atages16–24years,aboutaquarter(23%)ofpeoplewithamentaldisorderhadamusculoskeletalcondition.Thisproportionincreasedto87%intheoldestagegroup.Overall,48%ofpeoplewithamentaldisorderhadamusculoskeletalcondition.


Figure 7: Presence of musculoskeletal conditions in people with mental disorders, 2007

16–24 25–34 35–44 45–54 55–64 65–74 75–85 Age group (years)

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800

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Musculoskeletal conditions without mental disorders

Musculoskeletal conditions with mental disorders

16–24 25–34 35–44 45–54 55–64 65–74 75–85 Age group (years)

Mental disorders without musculoskeletal conditions

Mental disorders with musculoskeletal conditions

0

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400

600

800

Number (’000)


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Types of mental disorders in people with musculoskeletal conditions

Thissectionexaminestheprevalenceofsomebroadtypesofmentaldisordersinpeoplewithbroadgroupsofmusculoskeletalconditionsandidentifieswhichcombinationsofmusculoskeletalconditionsandmentaldisordersaremostcommon.Itonlyincludespeoplewhohavebothamusculoskeletalconditionandamentaldisorder.Musculoskeletalconditionsaretakenasthereferencepopulationbecausethecausalpathwaysaremorelikelytobefrommusculoskeletalconditionstomentaldisordersthantheotherwayaround.

Asalreadynoted,about25%ofpeoplewithamusculoskeletalconditionalsohadamentaldisorder(over1.5millionAustraliansaged16–85years).Theprevalencerateofmentaldisorderswashigherinpeoplewithbackandneckproblems(28%)thanthosewitharthritis,rheumatismandgout(21%)(Table2).

Table 2: Types of mental disorders in people with various musculoskeletal conditions, 2007

Musculoskeletal conditionAny anxiety

disorderAny affective

disorderAny substance-use

disorderAny mental

disorder

Number (’000)

Arthritis, rheumatism, gout 529 220 108 657

Back and neck problems 961 472 274 1,266

Any musculoskeletal condition 1,161 559 326 1,542

Rate (per cent)

Arthritis, rheumatism, gout 16.6 6.9 3.4 20.6

Back and neck problems 21.4 10.5 6.1 28.2

Any musculoskeletal condition 18.9 9.1 5.3 25.1

Notes 1. Based on 12-month prevalence. 2. Ages 16–85 years. 3. Numbers and percentages may not add up correctly because more than one musculoskeletal condition and mental disorder may be recorded. Source: AIHW analysis of ABS 2007 Survey of Mental Health and Wellbeing CURF.

Anxietydisordersarethemostcommongroupofmentaldisordersamongpeoplewithamusculoskeletalcondition,astheyareamongthegeneralcommunity.Allclassesofmentaldisorders(anxiety,affectiveorsubstance-use)weremorecommonlypresentinpeoplewithbackandneckproblemsthanwitharthritis,rheumatismandgout.

Differences by sex

Overall,prevalenceratesofmentaldisordersarehigherinfemaleswithamusculoskeletalcondition(28%)thanmales(22%)(Table3).Thehigherprevalenceofmentaldisordersamongfemaleswithmusculoskeletalconditionsisapparentforbothanxietyandaffectivedisorders.However,substance-usedisordersaremorecommonamongmaleswithmusculoskeletalconditionsthanamongfemales.Thepatterninpeoplewithmusculoskeletalconditionsreflectstheprevalenceinthegeneralcommunity.




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Table 3: Types of mental disorders in people with musculoskeletal conditions, by sex, 2007

SexAny anxiety

disorderAny affective

disorderAny substance-use

disorderAny mental

disorder

Number (’000)

Males 469 222 201 671

Females 697 334 128 862

Persons 1,165 556 323 1,534

Rate (per cent)

Males 16.8 7.9 7.2 21.9

Females 20.8 9.9 3.6 28.2

Persons 18.9 9.1 5.3 25.1

Notes 1. Based on 12-month prevalence. 2. Ages 16–85 years. 3. Numbers and percentages may not add up correctly because more than one musculoskeletal condition and mental disorder may be recorded. Source: AIHW analysis of ABS 2007 Survey of Mental Health and Wellbeing CURF.

Age distributions

Asnotedpreviously,comorbiditybetweenmusculoskeletalconditionsandmentaldisordersismostcommoninthe45–54yearsagegroup(Figure8).Thecomorbidityagedistributionswerebroadlysimilaracrossallthreementaldisordertypes.

Note: Based on 12-month prevalence.Source: AIHW analysis of ABS 2007 National Survey of Mental Health and Wellbeing CURF.

Figure 8: Age-specific comorbidity of various types of mental disorders in people with musculoskeletal conditions, 2007

16–24 25–34 35–44 45–54 55–64 65–74 75–85

Age group (years)

0

5

10

15

20

25

30

Percent

Anxiety disorders

A�ective disorders

Substance-use disorders


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Conclusion

Thisstudyshowsthereissignificantcomorbiditybetweenmusculoskeletalconditionsandmentalhealthproblems.One-quarterofadultsaged16–85yearswithamusculoskeletalconditionalsohadamentaldisorder.Fromtheotherperspective,nearlyhalfofallpeopleinthatagegroupwithamentalhealthdisorderalsohadamusculoskeletalcondition.Thisresultsin1.5millionpeople(10%ofthoseaged16–85years)havingatleastonemusculoskeletalconditionandonementalhealthdisorder.

Thisalsosuggeststheexistenceofanunderlyingrelationshipbetweenthetwoconditions,withtheobservedcomorbiditybeinghigherthanexpected.Whilethecausaldirectionsarenotfullyunderstood,theirhighcomorbidityindicatestheneedforhealth-careproviderstobeawareofthecomplextreatmentandmanagementrequirementsofpeoplewithlong-termmusculoskeletalconditions.

Acknowledgments

ThisreportwaspreparedbyNailaRahman,KuldeepBhatiaandStanBennett.

TheNationalCentreforMonitoringArthritisandMusculoskeletalConditionsattheAustralianInstituteofHealthandWelfare(AIHW)acknowledgestheinputofLyleBaker,MarkCooper-Stanbury,LynelleMoonandvariousmembersoftheArthritisDataWorkingGroup/SteeringCommitteeinthepreparationofthisreport.

TheAustralianGovernmentDepartmentofHealthandAgeingfundedthepreparationandpublicationofthisreport.




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Appendix: Statistical table and methods

Table A1: People with musculoskeletal conditions, mental disorders and their comorbidity by age and sex, 2007

Age group

Population Musculoskeletal conditions Mental disorders Comorbidity

Number (’000)

Number (’000)

Rate (per cent)

Number (’000)

Rate (per cent)

Number (’000)

Rate (per cent)

Persons

16–24 2,545 315.9 12.4 671.1 26.4 155.6 6.1

25–34 2,812 622.9 22.2 698.4 24.8 239.5 8.5

35–44 3,070 1,046.2 34.1 716.4 23.3 361.4 11.8

45–54 2,859 1,352.5 47.3 613.7 21.5 409.5 14.3

55–64 2,324 1,287.8 55.4 316.7 13.6 225.0 9.7

65–74 1,434 896.1 62.5 123.8 8.6 92.4 6.4

75–85 971 622.6 64.1 57.7 5.9 50.3 5.2

16–85 16,015 6,143.9 38.4 3,197.8 20.0 1,533.7 9.6

Males

16–24 1,299 122.9 9.5 296.3 22.8 59.2 4.6

25–34 1,414 272.3 19.3 322.5 22.8 105.6 7.5

35–44 1,534 512.4 33.4 319.0 20.8 180.1 11.7

45–54 1,405 617.8 44.0 262.1 18.6 184.5 13.1

55–64 1,159 588.2 50.8 126.5 10.9 86.9 7.5

65–74 699 403.2 57.7 53.8 7.7 36.6 5.2

75–85 440 268.2 60.8 21.9 5.0 18.5 4.2

Total 7,952 2,784.9 35.0 1,402.1 17.6 671.4 8.4

Females

16–24 1,246 193.0 15.5 374.8 30.1 96.4 7.7

25–34 1,398 350.6 25.1 375.8 26.9 133.9 9.6

35–44 1,536 533.8 34.8 397.5 25.9 181.3 11.8

45–54 1,453 734.7 50.6 351.6 24.2 225.0 15.5

55–64 1,165 699.6 60.1 190.2 16.3 138.1 11.9

65–74 735 492.9 67.1 70.0 9.5 55.8 7.6

75–85 530 354.4 66.8 35.8 6.8 31.7 6.0

Total 8,064 3,359.0 41.7 1,795.8 22.3 862.3 10.7

NotesMusculoskeletal conditions and mental disorders include comorbidity.Comorbidity in the occurrence of musculoskeletal conditions and mental disorders together in one person. Rate is the number as a percentage of the corresponding population.

Source: AIHW analysis of ABS 2007 National Survey of Mental Health and Wellbeing CURF.




17

Definitions and methods

Prevalence

Prevalencereferstothenumberorproportion(ofcases,instances,etc.)presentinapopulationatagiventime.Prevalencedataprovideanindicationoftheextentofthepresenceofaconditionandmayhaveimplicationsfortheprovisionofservicesinacommunity.Theformulaforcalculatingprevalenceis:

Mostoftheinformationavailableontheprevalenceofarthritisandmusculoskeletalconditionsisbasedupontheexistenceoftheseconditionslongterm,thatistheconditionshavebeenpresentorarelikelytobepresentfor6monthsormore.Acute,one-offcases,lastinglessthan6months,areexcludedfromthecount.

Age-specific rates

Age-specificratesarecalculatedbydividingthenumberofcasesoccurringineachspecifiedagegroupbytheestimatedresidentpopulationforthatagegroup.Inthispublication,theratesareexpressedascasesper100population(that is,asapercentage).

Excess comorbidity

Excesscomorbidityisestimatedasthedifferencebetweentheobservedcomorbidityandtheexpectedcomorbidity,thatis:

Excess comorbidity = observed comorbidity – expected comorbidity.

Theobservedcomorbidityisthenumberofpeoplewhohadatleastonemusculoskeletalconditionandatleastonementaldisorder.

Theexpectedcomorbidityistheestimatednumberofpeoplewhomightbeexpectedtohavehadatleastonemusculoskeletalconditionsandonementaldisorder.Assumingthattheoccurrenceofmusculoskeletalconditionsandmentaldisordersareindependent,theexpectedcomorbidityistheproductofthetwoobservedprevalenceratestimesthepopulationnumber.

Note:Thismethodproducesaconservative(underestimate)of‘excess’comorbidity.

Prevalence =

* during speci�ed time period

Number of existing cases*

Population at risk*


18

Worked example

Forexample,usingTableA1:

Forpersonsaged16–24yearstheobservedcomorbidityis155,600(arateof6.1%).

Theobservedprevalenceratesare12.4%formusculoskeletalconditionsand26.4%formentaldisorders.Theirproductis3.3%whichistheexpectedcomorbidityrate.Thecomorbidity(number)is3.3%×2,545,000=83,300.

Excesscomorbidity=155,600–83,300=72,000(tothenearestthousand).

© Australian Institute of Health and Welfare 2010

This work is copyright. Apart from any use as permitted under the Copyright Act 1968, no part may be reproduced without prior written permission from the Australian Institute of Health and Welfare. Requests and enquiries concerning reproduction and rights should be directed to the Head, Communications, Media and Marketing Unit, Australian Institute of Health and Welfare, GPO Box 570, Canberra ACT 2601.

This publication is part of the Australian Institute of Health and Welfare’s Bulletin series. A complete list of the Institute’s publications is available from the Institute’s website <www.aihw.gov.au>.

ISSN 1446-9820 ISBN 978-1-74249-063-2

AIHW bulletin no. 80

Suggested citation

Australian Institute of Health and Welfare 2010. When musculoskeletal conditions and mental disorders occur together. Cat. no. AUS 129. Canberra: AIHW.

Australian Institute of Health and Welfare

Board Chair Hon. Peter Collins, AM, QC

Director Penny Allbon

Any enquiries about or comments on this publication should be directed to:

Dr Naila Rahman National Centre for Monitoring Arthritis and Musculoskeletal Conditions Australian Institute of Health and Welfare GPO Box 570 Canberra ACT 2601 Phone: (02) 6244 1057 Email: [email protected]

Published by the Australian Institute of Health and Welfare

Printed by PMP Limited

when musculoskeletal conditions and mental disorders occur

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