Chronic physical illnesses, mental health disorders, and psychological features as potential risk factors for back pain from childhood to young adulthood: a systematic review with meta-analysis

  • Amber M. BeynonEmail author
  • Jeffrey J. Hebert
  • Christopher J. Hodgetts
  • Leah M. Boulos
  • Bruce F. Walker
Review Article



To report evidence of chronic physical illnesses, mental health disorders, and psychological features as potential risk factors for back pain in children, adolescents, and young adults.


This systematic review and meta-analysis included cohort and inception cohort studies that investigated potential risk factors for back pain in young people. Potential risk factors of interest were chronic physical illnesses, mental health disorders (e.g. depression, anxiety), and other psychological features (e.g. coping, resistance). Searches were conducted in MEDLINE, Embase, CINAHL, and Scopus from inception to July 2019.


Nineteen of 2167 screened articles were included in the qualitative synthesis, and data from 12 articles were included in the meta-analysis. Evidence from inception cohort studies demonstrated psychological distress, emotional coping problems, and somatosensory amplification to be likely risk factors for back pain. Evidence from non-inception cohort studies cannot distinguish between risk factors or back pain triggers. However, we identified several additional factors that were associated with back pain. Specifically, asthma, headaches, abdominal pain, depression, anxiety, conduct problems, somatization, and ‘feeling tense’ are potential risk factors or triggers for back pain. Results from the meta-analyses demonstrated the most likely risk factors for back pain in young people are psychological distress and emotional coping problems.


Psychological features are the most likely risk factors for back pain in young people. Several other factors were associated with back pain, but their potential as risk factors was unclear due to risk of bias. Additional high-quality research is needed to better elucidate these relationships.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.


Back pain Systematic review Meta-analysis Risk factors Children Young adult 



Quality In Prognostic Studies tool


Odds ratio


Risk ratio


Confidence intervals


Number of participants


Standard deviation


Not reported


Not applicable


Back pain


Low back pain


Mid-back pain




Body mass index



We would like to thank Cody Davenport for his assistance with the study screening process.

Authors’ contribution

AB, JH, and BW were involved with the concept and design of the study. LB conducted the searches. AB and CH conducted study selection and data extraction. AB analysed and interpreted the data with the assistance of BW, JH, and CH. AB drafted the manuscript and performed revisions with substantial feedback and editing from all authors. All authors read and approved the final manuscript.


This study was funded by a scholarship from Murdoch University, Western Australia and funding provided by Chiropractic Australia Research Foundation. JH receives salary support from the Canadian Chiropractic Research Foundation and the New Brunswick Health Research Foundation. The funding sources had no involvement in study design, analysis, interpretation, or manuscript preparation.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6278_MOESM1_ESM.pptx (156 kb)
Supplementary material 1 (PPTX 155 kb)
586_2019_6278_MOESM2_ESM.pdf (142 kb)
Supplementary material 2 (PDF 142 kb)
586_2019_6278_MOESM3_ESM.pdf (117 kb)
Supplementary material 3 (PDF 116 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.College of ScienceHealth, Engineering and Education, Murdoch UniversityMurdochAustralia
  2. 2.Faculty of KinesiologyUniversity of New BrunswickFrederictonCanada
  3. 3.Maritime SPOR SUPPORT UnitHalifaxCanada

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