title: Emotional distress drives health services overuse in patients with acute low back pain: a longitudinal observational study.
abstract: To determine whether emotional distress reported at the initial consultation affects subsequent healthcare use either directly or indirectly via moderating the influence of symptoms.
  
  
  
  Longitudinal observational study of 2891 participants consulting primary care for low back pain. Negative binomial regression models were constructed to estimate independent effects of emotional distress on healthcare use. Potential confounders were identified using directed acyclic graphs.
  
  
  
  After the initial consultation, participants had a mean (SD) of one (1.2) visit for back pain over 3 months, and nine (14) visits for back pain over 12 months. Higher reports of anxiety during the initial consultation led to increased short-term healthcare use (IRR 1.06, 95 % CI 1.01-1.11) and higher reports of depression led to increased long-term healthcare use (IRR 1.04, 95 % CI 1.02-1.07). The effect sizes suggest that a patient with a high anxiety score (8/10) would consult 50 % more frequently over 3 months, and a person with a high depression score (8/10) would consult 30 % more frequently over 12 months, compared to a patient with equivalent pain and disability and no reported anxiety or depression.
  
  
  
  Emotional distress in the acute stage of low back pain increased subsequent consultation rates. Interventions that target emotional distress during the initial consultation are likely to reduce costly and potentially inappropriate future healthcare use for patients with non-specific low back pain.
authors.affiliation: Neuroscience Research Australia, Barker Street, Randwick, Sydney, Australia.|Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Adrian C
authors.initials: AC
authors.lastname: Traeger
authors.affiliation: Neuroscience Research Australia, Barker Street, Randwick, Sydney, Australia.|Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Markus
authors.initials: M
authors.lastname: Hübscher
authors.affiliation: Institute of Public Health, University of Heidelberg, Heidelberg, Germany.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Henschke
authors.affiliation: Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.|The George Institute for Global Health, University of Sydney, Sydney, Australia.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Williams
authors.affiliation: Hunter Medical Research Institute and School of Medicine and Public Health, University of Newcastle, Newcastle, Australia.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Maher
authors.affiliation: Neuroscience Research Australia, Barker Street, Randwick, Sydney, Australia.|Sansom Institute for Health Research, University of South Australia, Adelaide, Australia.
authors.forename: G Lorimer
authors.initials: GL
authors.lastname: Moseley
authors.affiliation: Neuroscience Research Australia, Barker Street, Randwick, Sydney, Australia.|Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
authors.forename: Hopin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Neuroscience Research Australia, Barker Street, Randwick, Sydney, Australia. j.mcauley@neura.edu.au.|Prince of Wales Clinical School, University of New South Wales, Sydney, Australia. j.mcauley@neura.edu.au.
authors.forename: James H
authors.initials: JH
authors.lastname: McAuley
mesh_terms: D000208:Acute Disease; D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D001315:Australia / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D017116:Low Back Pain / Q000453:epidemiology / Q000523:psychology*; D008297:Male; D000069342:Medical Overuse / Q000706:statistics & numerical data*; D008875:Middle Aged; D013315:Stress, Psychological / Q000453:epidemiology*
keywords: Depressive symptoms; Low back pain; Medical overuse; Primary healthcare