title: Depression and anxiety as major determinants of neck pain: a cross-sectional study in general practice.
abstract: BACKGROUND
  Although psychosocial factors are known to be highly linked with neck pain, current therapies focus on somatically based interventions such as medicinal or manipulatory therapies. This study examines how socio-demographic, psychosocial and medical history and health-promoting lifestyle factors interact with neck pain in general practice patients.
  
  
  METHODS
  This is a cross-sectional survey including 448 patients from a general practice setting in Germany. Participants completed a comprehensive questionnaire including the Neck Pain and Disability Scale German version (NPAD-d) and the Hospital Anxiety and Depression Scale. Crude and adjusted regression analyses were done to assess the relationship between neck pain and socio-demographic, psychosocial and medical history and health-promoting lifestyle factors.
  
  
  RESULTS
  Both in crude and adjusted regression analyses, depression and anxiety were highly significantly linked with increasing levels of neck pain. Educational level, deficits in social support and physical exercise were associated with neck pain in bivariate analyses, but these associations did not persist with adjustment for depression and anxiety. When investigating levels of depression and anxiety by NPAD-d quartile subgroups, those who were identified to have depressive mood or to be anxious were very likely to be in the group with the highest levels of neck pain.
  
  
  CONCLUSIONS
  The higher the neck pain level, the more attention should be paid to psychosocial distress as a related burden. Further research is needed to elucidate the causality and the direction of the association between psychosocial distress and neck pain and to determine the benefit of psychosocial interventions.
authors.affiliation: Department of General Practice and Family Medicine, University of Göttingen, Göttingen, Germany. eblozik@gwdg.de
authors.forename: Eva
authors.initials: E
authors.lastname: Blozik
authors.forename: Daria
authors.initials: D
authors.lastname: Laptinskaya
authors.forename: Christoph
authors.initials: C
authors.lastname: Herrmann-Lingen
authors.forename: Helene
authors.initials: H
authors.lastname: Schaefer
authors.forename: Michael M
authors.initials: MM
authors.lastname: Kochen
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Himmel
authors.forename: Martin
authors.initials: M
authors.lastname: Scherer
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D004185:Disability Evaluation; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000453:epidemiology* / Q000523:psychology*; D010147:Pain Measurement; D015995:Prevalence; D011584:Psychology; D012307:Risk Factors; D012647:Self-Assessment; D017678:Sex Distribution; D013315:Stress, Psychological / Q000453:epidemiology*; D011795:Surveys and Questionnaires