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      Frequency of and Various Factors Associated with Stress, Anxiety, and Depression among Low Back Pain Patients

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      Cureus
      Cureus
      lower back pain, mental distress, dass-21

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          Abstract

          Objective

          To measure the frequency of depression, anxiety, and stress and its association with other variables i.e., age, gender, and off work hours among low back pain (LBP) patients attending an orthopedic outpatient department (OPD) at a private hospital in Jeddah, Saudi Arabia (SA).

          Methodology

          This is the cross-sectional study, which was done in a secondary care hospital of Jeddah, SA. Data was collected between the periods of 2017-2018. All patients who attended orthopaedic OPD with LBP were included in this study and were requested to fill the Depression, Anxiety, Stress Scale-21 (DASS-21) questionnaire. The gathered data were analyzed through the Statistical Package for Social Sciences (SPSS) version 23 (SPSS Inc., Chicago, IL). One-way analysis of variance (ANOVA) was used to compare the mean difference in depression, anxiety, and stress scores between genders, age, and number of leaves from their work.

          Results

          Three hundred sixty patients came to the orthopedic OPD with the primary complaint of LBP, 318 (88.3%) were male while 42 (11.7%) were female. The study showed that among these patients 24 (6.7%) subjects were suffering from the depression while 136 (37.8%) from anxiety and 167 (46.4%) from stress. Linear regression analysis showed that depression was negatively associated with age and stress was negatively associated with the off work because of the severity. 

          Conclusion

          In conclusion, the findings of this study revealed that LBP and mental distress are related to each other. This finding urges physicians to check and treat the mental distress in patients with LBP for a better outcome.

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          Most cited references19

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          A review of psychological risk factors in back and neck pain.

          S J Linton (2000)
          The literature on psychological factors in neck and back pain was systematically searched and reviewed. To summarize current knowledge concerning the role of psychological variables in the etiology and development of neck and back pain. Recent conceptions of spinal pain, especially chronic back pain, have highlighted the role of psychological factors. Numerous studies subsequently have examined the effects of various psychological factors in neck and back pain. There is a need to review this material to ascertain what conclusions may be drawn. Medical and psychological databases and cross-referencing were used to locate 913 potentially relevant articles. A table of 37 studies was constructed, consisting only of studies with prospective designs to ensure quality. Each study was reviewed for the population studied, the psychological predictor variables, and the outcome. The available literature indicated a clear link between psychological variables and neck and back pain. The prospective studies indicated that psychological variables were related to the onset of pain, and to acute, subacute, and chronic pain. Stress, distress, or anxiety as well as mood and emotions, cognitive functioning, and pain behavior all were found to be significant factors. Personality factors produced mixed results. Although the level of evidence was low, abuse also was found to be a potentially significant factor. Psychological factors play a significant role not only in chronic pain, but also in the etiology of acute pain, particularly in the transition to chronic problems. Specific types of psychological variables emerge and may be important in distinct developmental time frames, also implying that assessment and intervention need to reflect these variables. Still, psychological factors account for only a portion of the variance, thereby highlighting the multidimensional view. Because the methodologic quality of the studies varied considerably, future research should focus on improving quality and addressing new questions such as the mechanism, the developmental time factor, and the relevance that these risk factors have for intervention.
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            Social and Emotional Aging

            The past several decades have witnessed unidimensional decline models of aging give way to life-span developmental models that consider how specific processes and strategies facilitate adaptive aging. In part, this shift was provoked by the stark contrast between findings that clearly demonstrate decreased biological, physiological, and cognitive capacity and those suggesting that people are generally satisfied in old age and experience relatively high levels of emotional well-being. In recent years, this supposed “paradox” of aging has been reconciled through careful theoretical analysis and empirical investigation. Viewing aging as adaptation sheds light on resilience, well-being, and emotional distress across adulthood.
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              The validity of the 21-item version of the Depression Anxiety Stress Scales as a routine clinical outcome measure

              This study aimed to test the validity of the 21-item Depression Anxiety Stress Scales (DASS-21) as a routine clinical outcome measure in the private in-patient setting. We hypothesized that it would be a suitable routine outcome instrument in this setting.
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                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                19 September 2019
                September 2019
                : 11
                : 9
                : e5701
                Affiliations
                [1 ] Orthopedics, Liaquat College of Medicine and Dentistry, Karachi, PAK
                [2 ] Family Medicine, King Abdulaziz University, Jeddah, SAU
                [3 ] Misc, Dow University, Karachi, PAK
                [4 ] Misc, King Abdulaziz University, Jeddah, SAU
                Author notes
                Article
                10.7759/cureus.5701
                6823031
                31720169
                c8302fa3-446d-4e14-8637-127a5dbd66fc
                Copyright © 2019, Azfar et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 8 September 2019
                : 19 September 2019
                Categories
                Psychiatry
                Orthopedics
                Rheumatology

                lower back pain,mental distress,dass-21
                lower back pain, mental distress, dass-21

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