TOPLINE

Mental health conditions in older adults with back, neck, or spine pain were associated with a 78% higher 3-year risk for subsequent cognitive impairment (CI), with the highest risk for schizophrenia, bipolar disorder, and suicidal behavior, a new real-world study showed. Conversely, patients with preexisting CI had a higher risk of developing mental health conditions, particularly bipolar disorder and schizophrenia.

METHODOLOGY

• A retrospective cohort study used electronic health record data from the TriNetX US Collaborative Network (2016-2021).
• More than 1.8 million adults aged 65 years or older without mental health conditions or CI but with newly documented back, neck, and spine pain were assigned to the control group. They were compared with the study group, which consisted of patients with back, neck, and spine pain and either preexisting mental health conditions (n = 492,103) or CI (n = 36,560).
• 3-year risk for CI was assessed among patients with prior mental health conditions, and 3-year risk for mental health conditions was assessed among patients with prior CI.

TAKEAWAY

• Patients with any prior mental health condition had a higher 3-year risk for CI (risk ratio [RR], 1.78) than control individuals.
• The highest 3-year risk for cognitive impairment was for schizophrenia (RR, 4.59), bipolar disorder (RR, 3.76), and suicidal behavior (RR, 3.19). In descending order of RRs, posttraumatic stress disorder, persistent mood disorder, depression, generalized anxiety disorder, substance use disorder, and panic disorder were also associated with a higher CI risk.
• Patients with prior CI had a higher risk for a subsequent mental health condition than control individuals (RR, 1.50), with the highest risk for bipolar disorder (RR, 4.81), schizophrenia (RR, 3.40), or suicidal behavior (RR, 1.91).
• Additional analyses showed that patients with any prior mental health condition had a hazard ratio of 1.81 for incident CI, whereas patients with prior CI had a hazard ratio of 2.00 for incident mental health conditions.

IN PRACTICE

By quantifying both directions of associations between mental health conditions and CI in patients with chronic pain, “our study fills a critical evidence gap and underscores the need for integrated care pathways that span primary care, pain management, psychiatry, and geriatrics,” the investigators wrote.

“In clinics without integrated models, these results suggest the value of brief, cross-specialty screening and facilitating referrals to specialized care,” they added.

SOURCE

The study was led by Mohammad Alipour-Vaezi, Grado Department of Industrial & Systems Engineering, Virginia Tech, Blacksburg, Virginia. It was published online on June 23 in PLOS One.

LIMITATIONS

The study was limited by incomplete capture of prior history, potential detection or surveillance bias, and a lack of data on longer-term cumulative incidence, competing-risk analysis, and a defined timeframe for assessing prior mental health conditions in those with pain.

DISCLOSURES

The study was funded by the Virginia Center on Aging and the Institute for Society, Culture and Environment at Virginia Tech. The investigators reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.