Back and neck pain and psychopathology in rural sub-Saharan Africa: evidence from the Gilgel Gibe Growth and Development Study, Ethiopia.
METHODS
Community-based cross-sectional analysis of the relation between symptoms of psychopathology and back pain (BP) or neck pain (NP) in rural southwest Ethiopia.


OBJECTIVE
Using data from a community-based sample, we assessed the prevalence and psychopathologic correlates of BP or NP in rural sub-Saharan Africa.


BACKGROUND
BP and NP are among the most prevalent pain conditions. Psychopathology has been shown to be associated with both BP and NP in developed and urban developing contexts. Little is known about the relation between psychopathology and BP or NP in the rural, developing context.


METHODS
Data on self-reported BP and NP, symptoms of depression, anxiety, and post-traumatic stress (PTS), gender, age, and socioeconomic status were collected from a representative cohort sample (N = 900) in rural southwest Ethiopia. We calculated univariate statistics to assess the prevalence of BP and NP. We used bivariate χ2 tests and multivariate logistic regression models to assess the relation between psychopathology and BP and NP.


RESULTS
The prevalence of BP was 16.7%; that of NP was 5.0%. In χ2 analyses, symptoms of depression, anxiety, and PTS were significantly associated with increased risk for each outcome. In models adjusted for age, household assets, and gender, depression symptomatology was associated with increased risk for BP (OR = 3.44, 95% CI: 2.37-5.00) and NP (OR = 4.92, 95% CI: 2.49-9.74). Anxiety symptomatology was also associated with increased risk for BP (OR = 2.88, 95% CI: 1.98-4.20) and NP (OR = 2.67, 95% CI: 1.41-5.09). PTS symptomatology was associated with increased risk for BP (OR = 2.89, 95% CI: 1.78-4.69).


CONCLUSIONS
In the first known study about the relation between psychopathologic symptomatology and BP and NP in a rural context in a developing country, the prevalence of BP and NP were comparable to published data in developed and developing countries. Symptoms of depression and anxiety were correlates of BP and NP, and symptoms of PTS were a correlate of BP. Comparative studies about the relation between psychopathology and chronic pain conditions between rural and urban contexts in the global south are needed.
From the *Center for Social Epidemiology and Population Health, Department of Epidemiology, University of Michigan, Ann Arbor, MI; †University of Michigan Medical School, Ann Arbor, MI; ‡Department of Anthropology, Emory University, Atlanta, GA; §Jimma University, Jimma, Ethiopia; ¶Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, MI; ∥Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI; and **Center for Global Health, University of Michigan, Ann Arbor, MI.
Abdulrahman M
AM
El-Sayed
Craig
C
Hadley
Fasil
F
Tessema
Ayalew
A
Tegegn
John A
JA
Cowan
Sandro
S
Galea
D000328:Adult; D001007:Anxiety / Q000523:psychology; D001416:Back Pain / Q000453:epidemiology* / Q000523:psychology; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000523:psychology; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D019547:Neck Pain / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011599:Psychopathology / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult