Depression: An important factor associated with disability among patients with chronic low back pain

Int J Psychiatry Med. 2015;49(3):187-98. doi: 10.1177/0091217415573937. Epub 2015 Apr 30.


Objective: The study aimed to compare the associations of pain indices, depression, anxiety, and somatic symptoms with disability among outpatients with chronic low back pain (CLBP).

Method: Consecutive orthopedics outpatients with CLBP in a medical center were enrolled. The Oswestry Disability Index and physical functioning and role limitations-physical of the Short-Form 36 were used as disability indices. The Hospital Anxiety and Depression Scale (HADS) and the Depression and Somatic Symptoms Scale were employed. Pain intensity was rated using a visual analogue scale. Multiple linear regressions were used to determine the impacts of these independent factors related to disability.

Results: Among 225 participants (122 male, 103 female) with CLBP, patients with major depressive disorder and associated leg symptoms of CLBP had higher disability indices. A tendency was noted that depression (HADS-depression) had the highest correlation to the three disability indices, followed by pain intensity, anxiety, and somatic symptoms. After controlling for demographic variables, HADS-depression explained the highest variance of disability, followed by pain intensity.

Conclusion: Depression was the most powerful factor associated with disability of CLBP among depression, anxiety, and somatic symptoms. Depression should be evaluated when investigating disability among patients with CLBP.

Keywords: Anxiety; depression; disability; low back pain; somatization.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Chronic Pain / epidemiology
  • Chronic Pain / physiopathology*
  • Comorbidity
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / physiopathology*
  • Disability Evaluation
  • Female
  • Humans
  • Low Back Pain / epidemiology
  • Low Back Pain / physiopathology*
  • Male
  • Middle Aged
  • Severity of Illness Index*