title: Diagnostic uncertainty, guilt, mood, and disability in back pain.
abstract: OBJECTIVE
  In the majority of patients a definitive cause for low back pain (LBP) cannot be established, and many patients report feeling uncertain about their diagnosis, accompanied by guilt. The relationship between diagnostic uncertainty, guilt, mood, and disability is currently unknown. This study tested 3 theoretical models to explore possible pathways between these factors. In Model 1, diagnostic uncertainty was hypothesized to correlate with pain-related guilt, which in turn would positively correlate with depression, anxiety and disability. Two alternative models were tested: (a) a path from depression and anxiety to guilt, from guilt to diagnostic uncertainty, and finally to disability; (b) a model in which depression and anxiety, and independently, diagnostic uncertainty, were associated with guilt, which in turn was associated with disability.
  
  
  METHODS
  Structural equation modeling was employed on data from 413 participants with chronic LBP.
  
  
  RESULTS
  All 3 models showed a reasonable-to-good fit with the data, with the 2 alternative models providing marginally better fit indices. Guilt, and especially social guilt, was associated with disability in all 3 models. Diagnostic uncertainty was associated with guilt, but only moderately. Low mood was also associated with guilt.
  
  
  CONCLUSIONS
  Two newly defined factors, pain related guilt and diagnostic uncertainty, appear to be linked to disability and mood in people with LBP. The causal path of these links cannot be established in this cross sectional study. However, pain-related guilt especially appears to be important, and future research should examine whether interventions directly targeting guilt improve outcomes.
authors.affiliation: Department of Psychology, Royal Holloway, University of London.
authors.forename: Danijela
authors.initials: D
authors.lastname: Serbic
authors.affiliation: Department of Psychology, Royal Holloway, University of London.
authors.forename: Tamar
authors.initials: T
authors.lastname: Pincus
authors.affiliation: School of Psychology, University of Surrey.
authors.forename: Chris
authors.initials: C
authors.lastname: Fife-Schaw
authors.affiliation: Physiotherapy Department, Imperial College Healthcare NHS Trust.
authors.forename: Helen
authors.initials: H
authors.lastname: Dawson
mesh_terms: D000328:Adult; D000339:Affect; D001007:Anxiety; D003430:Cross-Sectional Studies; D003863:Depression; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D006167:Guilt; D006801:Humans; D017116:Low Back Pain / Q000175:diagnosis* / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D035501:Uncertainty