1 INSERM, U669, University Paris- Sud , University Paris Descartes, UMR-S0669, Paris, France.

1. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Association between musculoskeletal disorders and depressive symptoms across age groups and contribution of socioeconomic and behavioural factors: A population-based studyNearkasenChau, PhD1, SlimaneBelbraouet, PhD2, Carmen Otero Sierra, PhD, MD3, Lorhandicap group1 1INSERM, U669, University Paris-Sud, University Paris Descartes, UMR-S0669, Paris, France. 2Human Nutrition Program, Department of health sciences, College of Arts and sciences, Qatar university; Ecole de Nutrition, University of Moncton, Canada; 3CERpIEResearch Centre for Corporate Excellence & Innovation, UPC UniversitatPolitècnicade Catalunya, Av. Diagonal, 647 planta 10, ETSEIB, 08028 Barcelona, Spain;

2. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Background and objectives • Mental disorders are common: • 450 millions people worldwide (Hosman et al., WHO report 2004) • 83 millions adults (18-65 yr, 27%) in European Union (Wittchen & Jacob, EurNeuropharmacol2005) • Depressive symptoms affect 23% of men and 31% of women (12-75 yr) in France (Beck et al., Paris: INPES, 2007) • Theyrepresent10% of total health care expediture, with direct & indirect costshigherthan cancer and diabetes(FondationFondamental2011) • Depressive symptoms (DPS) relate to unhealthy behaviours and disability, and may become the most frequent cause of disability worldwide (Penninx et al., ArchgenPsychiatry 1999; Khlat et al., Scand J Public Health 2010 ; WHO 2010; Chau et al., J OccupEnvionMed 2011)

3. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Background and objectives • Musculoskeletal disorders (MSD) are common: • Most cause of work absence and disability worldwide (Euller-Ziegler, J RheumatolSuppl 2003; Roquelaureet al., Arthritis & Rheumatism 2006) • Two-thirds of occupational diseases in France (2003) (Roquelaure et al., Arthritis & Rheumatism 2006) • Social disparities in MSD and associated DPS (Khlatet al., Scand J Public Health2010) • Severalageperiodsmaybedistinguished: • Young adults (18-29 yr) with generally less good work conditions and higher risk for psychosomatic and mental disorders (Chau et al., Int J Equity Health 2008; Legleye et al., J Affect Disorders 2010) • From 45-50 yr to retirement: disabilitiesappearwhile people are working • From 60-65 yr: after retirement working performance is not needed. • There are marked gender/age disparities in MSD, DPS, psychosomatic disorders, health behaviours (Baumann et al., Int J Health Geogr2007; Chau et al., Occup Med (London) 2009).

4. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Background and objectives Socioeconomiccontext of the study population: • The Lorraine region (2.3 millions inhabitants), in the North-East, was one of the leadingindustrialregionsin France following the second war. • It has been particularly exposed to labour market hardship during the past decades because of massive desindustrialisation and tertiarisationduring the last 50 years. Objectives: To assess in the Lorraine region: • The association between musculoskeletal disorders and depressivesymptomsamongmen and womenacrossage groups. • The contributions of • Socioeconomic factors: education, living alone, occupation, and income • and tobacco smoking, alcohol abuse, and obesity

5. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Methods • The sample included subjects aged 15+ years living in 1996 in 8,000 randomly selected households in the Lorraine region (1/100 of the population). • Study protocol : an application to participate and 3sendings of self-administered questionnaires at 1-month intervals • 3,460 householdsparticipated(44%), in 86% of them alleligible members took part • 6,234 subjects filled in a questionnaire, 34 with unknown gender or age • 6,200 subjects (2,951 men and 3,249 women) • The investigation was approved by the national review board (CNIL). • Written informed consent from respondents.

6. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Methods Depressive symptoms (Duke questionnaire, over the past week): 5-item scale (Parkersonet al., Med Care 1990; Guillemin et al., SantePublique 1997). • Giving up too easily, • Difficulty concentrating, • Sleeping disorders, • Tiredness, • Feeling depressed or sad. The scale was one-dimensional: factor analysis yielded the first eigenvalue of 1.32 much higher than the 2nd eigenvalue of 0.23 Cronbach alpha coefficient was satisfactory: 0.65 Score defined as the sum of items, range: 0 to 10 (best value) Cutoff value used: score 5 or over (giving similar prevalence in the literature)

7. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Covariates • Socioeconomicfactors: • sex, • age, • education, • living alone, • Occupation (former occupation for retired and inactive people): • Manager, head of firm, and professional • Craftsman, tradesman, intermediateprofessional • Clerk • Manualworker • Others • Insufficient income (coping with difficulties or getting into debt vs. comfortable, well off or earning just enough).

8. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Covariates • Tobacco smoking habit • Non smoker, currentsmoker, former smoker • Alcohol abuse: • withCut/Annoyed/Guilty/Eye-opener (CAGE) questionnaire(Beresford et al., Lancet 1990) • At least 2positive responses to four items: • Consumption considered excessive by the subject, • Consumption considered excessive by people around the subject, • Subject wishes to reduce consumption, • Consumption on waking. • Obesity • Computedwith self-reportedheight and weight, > 30 kg/m2

9. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Statisticalanalysis Associations of DPS or MSD with covariates: analyzed with logistic regression models which yield odds ratios (OR) Associations between DPS and MSD, and contribution of covariates: analyzed with logistic regression models ─ Model 0: Crude OR ─ Model 1: adjusted for education, living alone, occupation, and income ─ Model 2: Model 1 + smoking, alcohol abuse and obesity Contribution of covariates (%) = Reduction in OR computed with the following formula: (Crude OR – ORmodel j)/(Crude OR – 1) ; j = 1 or 2. STATA software (Stata, College Station, TX, USA) was used.

10. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results Table 1. Characteristics of subjects: %

11. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results

12. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results

13. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results Table 2. Associations between depressive symptoms and covariates according to age in men: crude odds ratio

14. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results Table 3. Associations between musculoskeletal disorders and covariates according to age in men: crude odds ratio

15. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results Table 4. Associations between depressive symptoms and covariates according to age in women: crude odds ratio

16. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results Table 5. Associations between musculoskeletal disorders and covariates according to age in women: crude odds ratio

17. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results Table 7. Associations between depressive symptoms and musculoskeletal disorders (both sexes combined): odds ratio (OR) and 95% CI

18. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results Table 8. Associations between depressive symptoms and musculoskeletal disorders in men: odds ratio (OR) and 95% CI

19. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Results Table 9. Associations between depressive symptoms and musculoskeletal disorders in women: odds ratio (OR) and 95% CI

20. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Conclusions • Prevalence of MSD and DPS: • Prevalence of MSD steadily increase with age from about 30% to about 85% for men and women • Prevalence of DPS slightly higher after 35 years for men and women • DPS risk associated with MSD across age groups: Higher risk for <25 yr and after 45 yr for men and women

21. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Conclusions • Covariates for DPS: • Primary school for 45-54 yr in men ─ 35-44 and 45-54 yr in women • Insufficient income for <55 yr in men ─ nearly all age groups in women • Smoking for <25 yr, alcohol abuse for most age groups in men and women • Obesity for 45-54 yr in women • Manual worker for from 45 yr to retirement in men • Service workers/clerks and manual worker for nearly all age groups in women • Covariates for MSD: • Low education (<university) for most age group after 25 yrin men ─ 35-44 yrin women • Insufficient income for 35-54 yr in men ─ 25 to 54 yr in women • Smoking for 25-34 yr in women • Alcohol abuse for <44 yr in men • Obesity for 25-34 yr in men • Most occupations for 35-54 yr (all ages for manualworkers) inmen • Service workers/clerks and manual worker after retirement in women

22. 1st WORLD CONGRESS ON HEALTHY AGEING, Kuala Lumpur, 19th-22nd March 2012 Conclusions Association between DPS and MSD: Men: • Higher after 45 yr • Higher contribution of covariates for ≤24 yr (about 20%) and for 45-54 yr (about 33%) • Small contribution of covariates (<14%) for other age groups Women: • Higher after 45 yr • Small contribution of covariates for 35-44 and 45-54 yr(11-12%) • Smaller contribution of covariates (≤8%) for other age groups Prevention for DPS associated with MSD should consider subject’s age and socioeconomic and behavioural characteristics