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Are Psychosocial Factors Associated With Low Back Pain and Work Absence for Low Back Pain in an Occupational Cohort?

Urquhart, Donna M. PhD*; Kelsall, Helen L. PhD*; Hoe, Victor C.W. MPH*,†; Cicuttini, Flavia M. PhD*; Forbes, Andrew B. PhD*; Sim, Malcolm R. PhD*

doi: 10.1097/AJP.0b013e31827ff0c0
Original Articles

Objectives: To examine the relationship between individual and work-related psychosocial factors and low back pain (LBP) and associated time off work in an occupational cohort.

Methods: A self-administered questionnaire was completed by nurses working across 3 major public hospitals. Participants provided sociodemographic data and information on the occurrence of LBP, time off work, and psychosocial factors.

Results: One thousand one hundred eleven participants (response rate 38.6%) were included in the study. Fifty-six percent of participants reported LBP in the previous year. When individual psychosocial factors were examined in the same model, the relationship between somatization and LBP persisted (OR 1.64; 95% confidence interval [CI], 1.35, 2.01). Low job security was also significantly associated with LBP independent of the other work-related factors (OR 0.82; 95% CI, 0.69, 0.98). Of those participants with LBP, 30% reported absence from work due to LBP. When absence from work was examined, negative beliefs (OR 0.97; 95% CI, 0.94, 1.00) and pain catastrophizing (OR 1.33; 95% CI, 1.04, 1.71) were independently associated with time off work, along with low job satisfaction (OR 0.71; 95% CI, 0.51, 0.97) and high job support (OR 1.35; 95% CI, 1.04, 1.75).

Conclusions: Somatization and low job security were found to be independently associated with occupational LBP, whereas negative beliefs, pain catastrophizing, reduced job satisfaction, and high job support were independently related to time off work. Longitudinal studies are needed to determine whether these individual and work-related psychosocial factors predict, or alternatively, are outcomes of pain and time off work associated with LBP.

*Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, Melbourne, Vic., Australia

Centre for Occupational and Environmental Health, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

The authors declare no conflict of interest. Supported by the Monash University Strategic Grant Scheme, Melbourne, Australia; and Monash Research Fund. D.M.U. was supported by an NHMRC Public Health Capacity Building Grant (546248) and a Monash Senior Postdoctoral Fellowship. H.L.K. was supported by an NHMRC Public Health Postdoctoral Fellowship (384354). V.C.W.H. was supported by the Ministry of Higher Education’s Academic Training Scheme, Putrajaya, Malaysia.

Reprints: Donna M. Urquhart, PhD, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, The Alfred Centre, Monash University, 99 Commercial Rd., Melbourne 3004, Vic., Australia (e-mail:

Received May 16, 2011

Accepted November 26, 2012

© 2013 by Lippincott Williams & Wilkins