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

J Rehabil Med. 2014 Sep;46(8):798-805. 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.

MeSH terms

  • Adult
  • Chronic Pain / complications
  • Chronic Pain / etiology
  • Chronic Pain / psychology*
  • Cross-Sectional Studies
  • Depressive Disorder / complications
  • Depressive Disorder / etiology
  • Depressive Disorder / psychology*
  • Fatigue / complications
  • Fatigue / etiology
  • Fatigue / psychology*
  • Female
  • Humans
  • Male
  • Mental Processes / physiology*
  • Middle Aged
  • Musculoskeletal Diseases / complications
  • Musculoskeletal Diseases / etiology
  • Musculoskeletal Diseases / psychology*
  • Return to Work / psychology*
  • Return to Work / statistics & numerical data
  • Severity of Illness Index
  • Sick Leave / statistics & numerical data*
  • Sleep Wake Disorders / complications
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / psychology*
  • Surveys and Questionnaires
  • Sweden
  • Time Factors