title: Psychological Distress in Acute Low Back Pain: A Review of Measurement Scales and Levels of Distress Reported in the First 2 Months After Pain Onset.
abstract: To characterize the measurement scales and levels of psychological distress reported among published studies of acute low back pain (LBP) in the scientific literature.
  
  
  
  Peer-reviewed scientific literature found in 8 citation index search engines (CINAHL, Embase, MANTIS, PsycINFO, PubMed, Web of Science, AMED, and Academic Search Premier) for the period from January 1, 1966, to April 30, 2015, in English, Danish, Norwegian, and Swedish languages.
  
  
  
  Cross-sectional, case-control, cohort, or randomized controlled trials assessing psychological distress and including participants drawn from patients and workers (or an identifiable subset) with acute LBP (<8wk). Three researchers independently screened titles, abstracts, and full-length articles to identify peer-reviewed studies according to established eligibility criteria.
  
  
  
  Descriptive data (study populations, definitions of LBP, distress measures) were systematically extracted and reviewed for risk of bias. Distress measures were described, and data were pooled in cases of identical measures. Reported levels of distress were contextualized using available population norms, clinical comparison groups, and established clinical cutoff scores.
  
  
  
  Of 10,876 unique records, 23 articles (17 studies) were included. The most common measures were the Beck Depression Inventory, the modified version of the Zung Self-Rated Depression Scale, the Center for Epidemiologic Studies-Depression Scale, and the Medical Outcomes Study 12-Item Short-Form Health Survey and Medical Outcomes Study 36-Item Short-Form Health Survey. Pooled results for these scales showed consistent elevations in depression, but not anxiety, and reduced mental health status in comparison with the general population.
  
  
  
  Based on the high consistency across studies using valid measures with a low to moderate risk of bias, there is strong evidence that psychological distress is elevated in acute LBP.
authors.affiliation: Liberty Mutual Research Institute for Safety, Hopkinton, MA; University of Massachusetts Medical School, Worcester, MA. Electronic address: william.shaw@libertymutual.com.
authors.forename: William S
authors.initials: WS
authors.lastname: Shaw
authors.affiliation: Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark; Nordic Institute of Chiropractic and Clinical Biomechanics, Odense M, Denmark.
authors.forename: Jan
authors.initials: J
authors.lastname: Hartvigsen
authors.affiliation: Liberty Mutual Research Institute for Safety, Hopkinton, MA.
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Woiszwillo
authors.affiliation: Department of Behavioral, Social, and Legal Sciences, Örebro University, Örebro, Sweden.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Linton
authors.affiliation: Harvard School of Public Health, Boston, MA; Uni Research Health, Bergen, Norway.
authors.forename: Silje E
authors.initials: SE
authors.lastname: Reme
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D006801:Humans; D017116:Low Back Pain / Q000523:psychology* / Q000534:rehabilitation*; D026741:Physical Therapy Modalities / Q000592:standards*; D013315:Stress, Psychological / Q000175:diagnosis* / Q000523:psychology*
keywords: Anxiety; Depression; Low back pain; Rehabilitation; Review [publication type]