Abstract
Background: Recent data suggest that psychosocial factors, including childhood and adulthood stressors, may play a significant role in the development of chronic musculoskeletal pain and other symptoms. The purpose of this study was to determine if traumatic experiences in childhood are associated with an increased risk of self-reported arthritis later in life.
Methods: We used longitudinal data (N=9,159) from the first 3 cycles of the National Population Health Survey (NPHS) in Canada. New cases of arthritis were identified using an interviewer-administered questionnaire. Psychological trauma in childhood or adolescence was measured by a 7-item questionnaire asking about physical abuse, fearful experiences, hospitalization, being sent away from home, and 3 types of parental disturbance. The effects of trauma were examined in a multivariable discrete-time proportional hazards model.
Results: The incidence of self-reported arthritis was 27.1 per 1,000 person-years. We found a relative risk of 1.17 (95% CI=0.92, 1.48) for one traumatic event and 1.27 (95% CI=0.99, 1.62) for two or more traumatic events. Independent effects were observed for prolonged hospitalization (HR=1.33, 95% CI=1.05, 1.68) and being very scared (HR=1.29, 95% CI=1.02, 1.62). In subgroup analyses, no significant interactions were found between trauma and sex, socio-economic status, or baseline health.
Conclusions: In this large prospective study, we found a moderate increase in the risk of arthritis among persons reporting multiple traumatic experiences in childhood.
RÉsumé
Contexte: Des données récentes donnent à penser que des facteurs psychosociaux, en particulier les agents stressants durant l’enfance et à l’âge adulte, pourraient jouer un rôle important dans le fait d’être atteint de douleurs musculo-squelettiques chroniques et d’autres symptômes. Nous avons cherché à déterminer si les expériences traumatisantes durant l’enfance sont associées à un risque accru d’arthrite (selon les déclarations des intéressés) plus tard au cours de la vie.
Méthode: Nous avons utilisé les données longitudinales (N=9 159) des trois premiers cycles de l’Enquête nationale sur la santé de la population (ENSP) au Canada. Les nouveaux cas d’arthrite ont été répertoriés à l’aide d’un questionnaire administré par un intervieweur. Nous avons mesuré les traumatismes psychologiques vécus durant l’enfance ou l’adolescence au moyen d’un questionnaire en sept éléments, portant sur la violence physique, les expériences effrayantes, les hospitalisations, le fait d’avoir été envoyé hors de la maison et trois types de perturbations parentales. Les effets des traumatismes ont été examinés à l’aide d’un modèle multivariable des dangers proportionnels en temps discret.
Résultats: Établi selon les déclarations des intéressés, le taux d’arthrite était de 27,1 pour 1 000 personnes par année. Nous avons observé un risque relatif de 1,17 (IC de 95 % =0,92–1,48) lorsqu’il n’y avait eu qu’un seul événement traumatisant, et de 1,27 (IC de 95 % = 0,99–1,62) lorsqu’il y en avait eu deux ou plus. Des effets indépendants ont été observés en ce qui a trait aux séjours prolongés à l’hôpital (HR [ratio de danger] =1,33, IC de 95 %=1,05–1,68) et aux grandes frayeurs (HR=1,29, IC de 95 % = 1,02–1,62). Dans les analyses par sous-groupe, aucune interaction significative n’a été observée entre les traumatismes et le sexe, le statut socioéconomique ou l’état de santé de référence.
Conclusions: Dans cette vaste étude prospective, nous avons constaté une hausse modérée du risque d’arthrite chez les personnes ayant vécu plusieurs expériences traumatisantes durant l’enfance.
Footnotes
Acknowledgements: The study was supported by a grant from the Canadian Population Health Initiative. Dr. Kopec was supported by a National Health Scholar Award.
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