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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



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

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Data availability

The data sets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.



Quality In Prognostic Studies tool


Odds ratio


Risk ratio


Confidence intervals

N :

Number of participants


Standard deviation


Not reported


Not applicable


Back pain


Low back pain


Mid-back pain

β :



Body mass index


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


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.

Author information




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.

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Correspondence to Amber M. Beynon.

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Beynon, A.M., Hebert, J.J., Hodgetts, C.J. et al. 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. Eur Spine J 29, 480–496 (2020).

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