Depressive and distress symptoms as predictors of low back pain, neck-shoulder pain, and other musculoskeletal morbidity: a 10-year follow-up of metal industry employees

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Abstract
Six-hundred-seven employees in 3 metal industry plants were studied for depressive and distress symptoms, musculoskeletal symptoms, and findings in the musculo-skeletal system made by a physiotherapist. Measurements were made 3 times at 5-year intervals. The mean distress and depressive symptom scores of the first 2 examinations predicted the change in several musculo-skeletal symptom measures during the second 5-year period, when the effects of age and occupational class were accounted for in multiple regression analysis. They also predicted the development in clinical musculoskeletal findings in men. The proportions of variance explained by the depressive and distress symptoms were modest in magnitude. Analogous analyses were made with reference to the reverse temporal sequence: musculoskeletal disorders were considered as predating the development in depressive and distress symptoms. The musculoskeletal symptom scores were associated with the change in the stress symptoms in men, as did the clinical findings in the neck-shoulder and low back regions. None of the musculoskeletal morbidity scores predicted the change in the depressive symptoms in either sex. We conclude that depressive symptoms predict future musculoskeletal disorders, but not vice versa, whereas the association of stress symptoms and musculoskeletal disorders is reciprocal.