Content » Vol 46, Issue 8

Original report

Relationship between sleep disturbance, pain, depression and functioning in long-term sick-listed patients experiencing difficulty in resuming work

Jürgen Linder, Gunilla Brodda Jansen, Kristina Schüldt Ekholm, Jan Ekholm
Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden. E-mail:
DOI: 10.2340/16501977-1833


Objective: To describe the frequency of reported sleeping, depression and pain problems, the severity of these problems and the degree of self-estimated difficulties in mental functions and activities in relation to the sleep disturbance and pain category group in patients on long-term sick-leave.
Design: Cross-sectional study.
Patients: A total of 1206 patients experiencing difficulty in resuming work.
Methods: Patient examinations by specialists in psychiatry, orthopaedic surgery and rehabilitation medicine. Validated questionnaires, including status regarding depression, sleep, pain and functioning were used.
Results: The prevalence of sleep disturbance was 83%; 74% of the patients with moderate/severe sleep disturbance also had moderate/severe pain problems and 26% had no/mild pain problems. Fifty-seven percent of the patients with no/mild sleep disturbance and 83% of the patients with moderate/
severe sleep disturbance also had depression. The degree of difficulty in performing the 6 selected International Classification of Functioning, Disability and Health activities and mental functions was higher for the category with moderate/severe sleep problems, compared with those with no/mild sleep problems.
Conclusion: To optimize rehabilitation for patients on long-term sick-leave experiencing difficulties in returning to work, the results indicate a need also to focus attention on sleep problems and not only on pain and depression. This may entail the planning of measures to improve decision-making and concentration and alleviate lassitude, fatigability, sadness and pessimistic thoughts.

Lay Abstract


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