Parental Chronic Pain and Aspects of Mental Health in Adolescent Offspring: The HUNT Study
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In Europe, approximately 20% of the adult population lives with moderate to severe chronic pain (Breivik et al., 2006). Reported findings suggest that the impact of parental chronic pain on the general wellbeing of the family is substantial (Roy, 2006). However, research examining the mental health of adolescents living with parental chronic pain is limited. In addition, most of the available studies were performed using small clinical samples of younger children and often lack information about paternal health status. The main aim of the present thesis was to investigate aspects of mental health in girls and boys for whom their mothers, fathers, or both parents have chronic pain and to compare those results with those of adolescents for whom neither parent has chronic pain. More specifically, the associations of parental chronic pain with symptoms of anxiety and depression and conduct problems in adolescents (Paper I), smoking, alcohol intoxication and drug use (Paper II) and selfesteem, social competence and family cohesion (Paper III) were explored. Cross-sectional data from the third wave of the Nord-Trøndelag Health Study (HUNT 3), which is a Norwegian population-based health survey that was conducted from 2006–2008, were used. The number of participants in the HUNT 3 survey was 50,839 adults (response rate of 54%), and 8,200 adolescents (response rate of 78%) participated in the adolescent part of the study (i.e., the Young-HUNT survey (target age: 13 to 19 years)). Statistics Norway provided data related to kinship and highest achieved parental education. The present target sample consisted of adolescents aged 13–18 years (n = 3,227) for whom information was available concerning maternal and paternal health status. Separate analyses were conducted for girls and boys, and associations between parental chronic pain and youth mental health were analyzed using multivariable regression analyses. The results indicated that parental chronic pain, particularly concurrent maternal and paternal chronic pain, was associated with aspects of mental health in adolescent offspring. In this group, girls whose parents had chronic pain had a two-fold higher risk of symptoms of anxiety and depression and reported lower levels of self-esteem, social competence, and perceived family cohesion compared with girls for whom neither parent had chronic pain (i.e., the reference group). Furthermore, boys whose parents had chronic pain also had a two-fold higher risk of symptoms of anxiety and depression and a higher risk of smoking and alcohol intoxication compared with boys in the reference group. Maternal chronic pain was associated with slightly increased levels of conduct problems and lower self-esteem in girls and with higher levels of social competence in boys in comparison to the girls and boys in the reference group. Paternal chronic pain was not associated with any outcome in the present study. These results remained significant after controlling for the effects of potential confounding factors, including parental mental health and cohabitation status. However, adjusting for parental smoking and parental symptoms of anxiety and depression attenuated the associations between parental chronic pain and boys’ substance use to a non-significant level. By using a large population-based sample of adolescents in combination with independent reports from their mothers and fathers, the current study provides the first estimates of the associations between concurrent maternal and paternal chronic pain and aspects of mental health in adolescent offspring. This study was also the first study to investigate the association between parental chronic pain and substance use in offspring. Taken together, all three papers highlight the importance of viewing chronic pain not only as a phenomenon that affects the individual but also as an issue that relates to the individual’s surroundings.