EPIDEMIOLOGY OF CHRONIC MUSCULOSKELETAL DISORDERS WITH SPECIAL ATTENTION TO PSYCHOLOGICAL FACTORS AND MEDICAL CARE UTILIZATION

Data from the United States Health and Nutrition Examination Survey 1971-1975 are used to describe the occurrence of chronic musculoskeletal disorders (both self-reported symptoms and physician-diagnosed disorders) in the general population, and to examine the relationship between these disorders and a measure of psychological distress (anxiety/depression) in the general population. The possible influence of the process of selection to medical care in producing associations between musculoskeletal symptoms and psychological distress is evaluated.;Persons with a history of chronic musculoskeletal symptoms reported higher levels of anxiety and depression than did persons without a history of musculoskeletal symptoms, even when potentially confounding demographic variables were controlled for. Persons in whom the examining physician noted musculoskeletal abnormalities also reported more psychological distress.;The specific diagnostic groups associated with the most anxiety/depression were rheumatoid arthritis and disc disorder. Persons with rheumatoid arthritis and disc disorder also reported the most disability and were most likely to be currently under medical supervision.;Among persons with a history of musculoskeletal symptoms, those currently in treatment reported more anxiety/depression than those not currently in treatment. This observed association between current medical treatment and psychological distress could be explained in terms of confounding by sex and disability. Persons with high levels of disability were more likely to be currently under medical supervision and also reported more anxiety/depression. Similarly, females were both more likely to be in treatment and to report high levels of anxiety/depression. Once the effects of sex and disability levels were analytically controlled for, the association between current medical care utilization was no longer statistically significant. The results of the analysis suggest that utilization status per se is not an important predictor of anxiety/depression level among persons with chronic musculoskeletal disorders.;Persons who reported a history of chronic musculoskeletal symptoms tended to be older and poorer than persons who did not report a history of symptoms. They were also more likely to be female, to have less than a high school education, and to be widowed. The association of female sex, older age and lower income with history of musculoskeletal symptoms persisted in a multivariate analysis.