European Spine Journal

, Volume 25, Issue 9, pp 2767–2773 | Cite as

Emotional distress drives health services overuse in patients with acute low back pain: a longitudinal observational study

  • Adrian C. Traeger
  • Markus Hübscher
  • Nicholas Henschke
  • Christopher M. Williams
  • Christopher G. Maher
  • G. Lorimer Moseley
  • Hopin Lee
  • James H. McAuleyEmail author
Original Article



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.


Low back pain Depressive symptoms Primary healthcare Medical overuse 



AT and HL are supported by a National Health and Medical Research Council PhD Scholarship. GLM is supported by a National Health and Medical Research Council research fellowship NHMRC ID 1061279. JM and MH are supported by a National Health and Medical Research Council project Grant ID 1047827. CM is supported by a National Health and Medical Research Council research fellowship NHMRC ID 1002081.

Compliance with ethical standards

Conflict of interest


Supplementary material

586_2016_4461_MOESM1_ESM.pdf (1002 kb)
Supplementary material 1 (PDF 1002 kb)


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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Adrian C. Traeger
    • 1
    • 2
  • Markus Hübscher
    • 1
    • 2
  • Nicholas Henschke
    • 3
  • Christopher M. Williams
    • 4
    • 5
  • Christopher G. Maher
    • 4
  • G. Lorimer Moseley
    • 1
    • 6
  • Hopin Lee
    • 1
    • 2
  • James H. McAuley
    • 1
    • 2
    Email author
  1. 1.Neuroscience Research AustraliaSydneyAustralia
  2. 2.Prince of Wales Clinical SchoolUniversity of New South WalesSydneyAustralia
  3. 3.Institute of Public HealthUniversity of HeidelbergHeidelbergGermany
  4. 4.Hunter Medical Research Institute and School of Medicine and Public HealthUniversity of NewcastleNewcastleAustralia
  5. 5.The George Institute for Global HealthUniversity of SydneySydneyAustralia
  6. 6.Sansom Institute for Health ResearchUniversity of South AustraliaAdelaideAustralia

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