Reducing the prevalence of low-back pain by reducing the prevalence of psychological distress: Evidence from a natural experiment and implications for health care providers

Health Serv Res. 2020 Oct;55(5):631-641. doi: 10.1111/1475-6773.13557.


Objective: To determine whether exogenously reduced psychological distress reduces reported low-back pain (LBP) and is associated with reduced medical visits for LBP.

Data sources: National Health Interview Survey, National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, 1998-2004.

Study design: We estimate a fuzzy regression discontinuity model in which a discontinuity in the prevalence of psychological distress is identified by exogenous national events. We examine whether this discontinuity induced a corresponding discontinuity in the prevalence of LBP. We additionally estimate a regression discontinuity model to determine associated changes in medical visits with LBP as the primary complaint.

Principal findings: The prevalence of LBP was discontinuously reduced by one-fifth due to the exogenous national discontinuous reduction in psychological distress. This discontinuity in LBP cannot be explained by discontinuities in employment, insurance, injuries/poisoning, general health status, or other factors. We find an associated three-fifth discontinuous reduction in medical visits with LBP as the primary complaint.

Conclusions: On a monthly basis, 2.1 million (P < .01) adults ceased to suffer LBP due to the national reduction in psychological distress, and associated medical visits with LBP as the primary complaint declined by 685 000 (P < .01).

Keywords: low‐back pain; medical visits; psychological distress; regression discontinuity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Economic Recession*
  • Female
  • Health Status
  • Health Surveys
  • Humans
  • Low Back Pain / epidemiology*
  • Low Back Pain / psychology*
  • Male
  • Middle Aged
  • Prevalence
  • Psychological Distress*
  • Regression Analysis
  • Risk Factors
  • Socioeconomic Factors
  • Terrorism / psychology*