title: Emotional distress as a predictor for low back disability: a prospective 12-year population-based study.
abstract: METHODS
  A population-based, prospective cohort.
  
  
  OBJECTIVE
  To study associations between emotional distress and long-term low back disability in a general population.
  
  
  BACKGROUND
  In primary and hospital care studies, emotional, cognitive, and personality factors have been associated with low back disability, while the association between distress and novel back pain episodes has been uncertain.
  
  
  METHODS
  A randomly drawn cohort of 1152 occupationally active persons aged 20-55 years was interviewed with a comprehensive psychosocial questionnaire in 1990, and was followed for 12 years in national registers over sickness, rehabilitation, and disability benefits. Data on emotional distress, earlier low back pain (LBP), education, life style, psychosocial, and work-related factors were collected at baseline.
  
  
  RESULTS
  Long-term benefits due to low back disability were granted to 131 persons (11.4%) in the follow-up period. In multivariate analysis, earlier LBP, emotional distress, low grade of education, and high physical job stress were associated with low back disability. Persons with both emotional distress and earlier back pain were most at risk for disability (hazard ratio 2.91, 95% confidence interval 1.60-5.29). Persons with emotional distress but no earlier episodes of LBP had no increased risk for low back disability (hazard ratio 0.71, 95% confidence interval 0.34-1.45).
  
  
  CONCLUSIONS
  Emotional distress is a predictor for low back disability in persons with earlier LBP, but not in persons without. To prevent low back disability, emotional distress should be considered and treated in persons with LBP.
authors.affiliation: Department of General Practice and Community Medicine, University of Oslo, Oslo, Norway. soren.brage@medisin.uio.no
authors.forename: Søren
authors.initials: S
authors.lastname: Brage
authors.forename: Inger
authors.initials: I
authors.lastname: Sandanger
authors.forename: Jan Franz
authors.initials: JF
authors.lastname: Nygård
mesh_terms: D000328:Adult; D015331:Cohort Studies; D006233:Persons with Disabilities; D004522:Educational Status; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017116:Low Back Pain / Q000150:complications / Q000503:physiopathology* / Q000523:psychology*; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D013312:Stress, Physiological / Q000150:complications; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D014937:Work