Psychological factors: anxiety, depression, and somatization symptoms in low back pain patients

Abdulbari Bener,^1–3 Mohamud Verjee,⁴ Elnour E Dafeeah,⁵ Omar Falah,⁴ Taha Al-Juhaishi,⁴ Josia Schlogl,⁴ Alhasan Sedeeq,⁴ Shehryar Khan<sup>4

1</sup>Department of Medical Statistics and Epidemiology, Hamad Medical Corporation, ²Department of Public Health, Weill Cornell Medical College, Doha, Qatar; ³Department of Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK; ⁴Department of Medical Education, Weill Cornell Medical College, ⁵Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar

Aim: To determine the prevalence of low back pain (LBP), investigate the sociodemographic characteristics of patients with LBP, and examine its association with psychological distress such as anxiety, depression, and somatization.
Subjects and methods: Of the 2742 patients approached, 2180 agreed to participate in this cross-sectional study (79.5% response rate). The survey was conducted among primary health care visitors from March to October 2012 and collected sociodemographic details and LBP characteristics. General Health Questionnaire-12 was used to identify the probable cases. Anxiety was assessed with Generalized Anxiety Disorder-7, depression was assessed with Patient Health Questionnaire-9, and somatization was measured with Patient Health Questionnaire-15.
Results: The study sample consisted of 52.9% males and 47.1% females. The prevalence of LBP was 59.2%, comprising 46.1% men and 53.9% women. LBP was significantly higher in Qataris (57.9%), women (53.9%), housewives (40.1%), and individuals with higher monthly income (53.9%). Somatization (14.9%) was observed more in LBP patients, followed by depression (13.7%) and anxiety disorders (9.5%). The most frequently reported symptoms were "headaches" (41.1%) and "pain in your arms, legs, or joints" (38.5%) in LBP patients with somatization. The most frequent symptoms among depressed LBP patients were "thinking of suicide or wanting to hurt yourself" (51.4%) and "feeling down, depressed, or hopeless" (49.2%). "Not being able to stop or control worrying" (40.2%), "worrying too much about different things" (40.2%), and "feeling afraid as if something awful might happen" (40.2%) were the most common anxiety symptoms in LBP patients. Psychological distress such as anxiety (9.5% versus 6.2%), depression (13.7% versus 8.5%), and somatization (14.9% versus 8.3%) were significantly higher in LBP patients.
Conclusion: The prevalence of LBP in this study sample was comparable with other studies. Furthermore, psychological distress such as anxiety, depression, and somatization were more prevalent in LBP patients compared to patients without LBP.

Keywords: somatization, anxiety, depression, low back pain, primary health care