Back pain may raise risk of mental health problems in low- and middle-income countries

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DepressionThe latest and largest study to investigate the connections between back pain and psychological illness in low- and middle-income countries was published this week in the journal General Hospital Psychiatry.

The research team—headed up by Patricia Schofield and Brendon Stubbs from Anglia Ruskin University, Cambridge, UK—took data from 190,595 individuals aged 18 or older across 43 countries, making it the largest study of its type. Of the 43 countries, 19 were low-income and 24 were middle-income.

The team used data from the World Health Survey 2002-2004, a project set up by the World Health Organization (WHO) to “generate information on the health of adult populations and health systems.”

Overall, in low- and middle-income countries, back pain affected 35.1% of the population, and 6.9% reported chronic back pain. Of the countries investigated, China’s levels of back pain were lowest, at 13.7%.

In some countries, more than half of respondents reported back pain; Nepal was highest with 57.1%. Similarly, 53.1% of Bangladeshis reported back pain, as well as 52% of people from Brazil.

The analysis of the questionnaire data showed that, when compared with people without back pain, those who did experience back pain were more than twice as likely to experience one of five mental health conditions—anxiety, depression, psychosis, stress, and sleep deprivation.

People with chronic back pain were also three times more likely to experience a depressive episode, and 2.6 times more likely to experience psychosis.

Interestingly, the results were relatively similar across all 43 low- and middle-income countries, regardless of their standing on the socioeconomic ladder.

“Our data shows that both back pain and chronic back pain are associated with an increased likelihood of depression, psychosis, anxiety, stress, and sleep disturbances. This suggests that back pain has important mental health implications which may make recovery from back pain more challenging. The exact reasons for this are yet to be established,” Stubbs says. “Further research is required to find out more about the links between these problems and to ensure effective treatments can be developed. It is also important that healthcare professionals are made aware of this link to refer patients to other services if necessary.”

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