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Gen Hosp Psychiatry. 2016 Nov - Dec;43:63-70. doi: 10.1016/j.genhosppsych.2016.09.008. Epub 2016 Sep 30.

The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries.

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Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, Box SE5 8AF, United Kingdom. Electronic address:
Research and Development Unit, ParcSanitariSant Joan de Déu, Universitat de Barcelona, FundacióSant Joan de Déu, Dr. Antoni Pujadas, 42, SantBoi de Llobregat, Barcelona 08830, Spain; Instituto de Salud Carlos III, Centro de InvestigaciónBiomédicaen Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid 28029, Spain.
Faculty of Education and Health, University of Greenwich, London, United Kingdom.
Geriatrics Division, Department of Medicine-DIMED, University of Padova, Italy; Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy.
Translational Psychiatry Research Group and Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
Institute of Clinical Research and Education in Medicine (IREM), Padova, Italy; Department of Neurosciences, University of Padova, Padova, Italy.
Kyambogo University, Kampala, Uganda; Butabika National Referral and Mental Health Hospital, Kampala, Uganda.
Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, United Kingdom.
MRC Unit for Lifelong Health & Ageing, University College London, 33 Bedford Place, London WC1B 5JU, United Kingdom.
Physiotherapy Service, Kings College Hospital NHS Foundation Trust, Denmark Hill, London, United Kingdom.
KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Leuven-Kortenberg, Belgium.



Back pain (BP) is a leading cause of global disability. However, population-based studies investigating its impact on mental health outcomes are lacking, particularly among low- and middle-income countries (LMICs). Thus, the primary aims of this study were to: (1) determine the epidemiology of BP in 43 LMICs; (2) explore the relationship between BP and mental health (depression spectrum, psychosis spectrum, anxiety, sleep disturbances and stress).


Data on 190,593 community-dwelling adults aged ≥18 years from the World Health Survey (WHS) 2002-2004 were analyzed. The presence of past-12 month psychotic symptoms and depression was established using questions from the Composite International Diagnostic Interview. Anxiety, sleep problems, stress sensitivity, and any BP or chronic BP (CBP) during the previous 30 days were also self-reported. Multivariable logistic regression analyses were undertaken.


The overall prevalence of any BP and CBP were 35.1% and 6.9% respectively. Significant associations with any BP were observed for subsyndromal depression [OR (odds ratio)=2.21], brief depressive episode (OR=2.64), depressive episode (OR=2.88), psychosis diagnosis with symptoms (OR=2.05), anxiety (OR=2.12), sleep disturbance (OR=2.37) and the continuous variable of stress sensitivity. Associations were generally more pronounced for chronic BP.


Our data establish that BP is associated with elevated mental health comorbidity in LMICs. Integrated interventions that address back pain and metal health comorbidities might be an important next step to tackle this considerable burden.


Anxiety; Back pain; Chronic back pain; Depression; Low- and middle-income countries; Mental health; Mental illness; Psychosis; Sleep problems; Stress sensitivity

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