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Pain drawings, interpreter support and clinical findings among immigrant patients on sick leave in Swedish primary health care
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Karolinska Inst, Ctr Family Med, Dept Neurobiol Caring Sci & Soc, Huddinge, Sweden.ORCID iD: 0000-0001-7761-6282
2019 (English)In: Primary Health Care Research and Development, ISSN 1463-4236, E-ISSN 1477-1128, Vol. 20, article id e137Article in journal (Refereed) Published
Abstract [en]

Aim: To evaluate the spread of pain and its correlates among immigrant patients on sick leave.

Background: Backache, outspread pain and sick-leave questions are problematic to handle primary health care, especially in multicultural settings.

Methods: Two hundred and thirty-five patients 20-45 years on paid sick leave (59% women, 93% foreign-born, mostly non-Europeans). Many had little formal education. One-third had professional interpreter support. The patients pointed out on their bodies where they felt pain. This information was transferred on a pain drawing [pain drawing fields (PDFs) 0-18] by a doctor. Major depression and psychosocial stressors were assessed using Diagnostic and Statistical Manual of Mental Disorders. Nociceptive locations for pain were established (pain-sites 0-18). Dependent variable was the number of PDFs. Independent variables were social data, sick leave, interpreter, depression, stress levels and number of pain sites. Calculations were done using descriptive methods and multi-variable linear regression in full models, by gender.

Findings: Many patients had depression (51% women versus 32% men). A majority were exposed to psychosocial stressors. Women had more PDFs, in median 5 [inter-quartile ranges (IQR) 4-8] versus men 3 (IQR 2-5), and also more pain sites, in median 3 (IQR 2-5) versus men in median 2 (IQR 1-3). For men, the regression calculations revealed that numbers of PDFs associated only with increasing numbers of pain sites (B 0.871 P < 0.001). For women, this association was weaker (B 0.364, P < 0.001), with significant values also for age (B 0.103) and sick leave > one year (B 0.767, P = 0.010), and a negative predicting value for interpreter support (B -1.198, P < 0.043). To conclude, PDFs associated often with somatic findings but varied much among the women. This implies potential problems regarding cause, function and sick leave questions. However, support by professional interpreters may facilitate a shared understanding with immigrant women having long-standing pain.

Place, publisher, year, edition, pages
Cambridge University Press, 2019. Vol. 20, article id e137
Keywords [en]
chronic pain, depression, immigrants, interpreter, primary care, sick leave
National Category
Public Health, Global Health, Social Medicine and Epidemiology General Practice
Identifiers
URN: urn:nbn:se:uu:diva-396727DOI: 10.1017/S1463423619000628ISI: 000488967900001PubMedID: 31581973OAI: oai:DiVA.org:uu-396727DiVA, id: diva2:1375740
Funder
Stockholm County CouncilAvailable from: 2019-12-05 Created: 2019-12-05 Last updated: 2019-12-12Bibliographically approved

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