Association of depression with sleep quality might be greater than that of pain intensity among outpatients with chronic low back pain

Hsin Yu Wang, Tsai Sheng Fu, Shih Chieh Hsu, Ching I. Hung

Research output: Contribution to journalJournal Article peer-review

28 Scopus citations


Purpose: No study to date has compared the associations of pain intensity, depression, and anxiety with insomnia among outpatients with chronic low back pain (CLBP). This study aimed to investigate this issue. Patients and methods: A total of 225 outpatients with CLBP were enrolled from a general orthopedics clinic. The Insomnia Severity Index was used to evaluate sleep quality. Major depressive disorder (MDD) and anxiety disorders were diagnosed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, Axis I Disorders. Two psychometric scales were used to evaluate depression and anxiety. The Visual Analog Scale was employed to assess pain intensity. Multiple linear regressions were performed to determine the association of insomnia with pain intensity, depression, and anxiety. Results: Among the 225 subjects, 58 (25.8%) had clinical insomnia; 83 (36.9%) had severe low back pain; 49 (21.8%) had MDD, including 21 (9.3%) with a current major depressive episode (MDE); and 52 (23.1%) had anxiety disorders. More than half (56.9%) of the subjects with CLBP and clinical insomnia had MDD and/or anxiety disorders. Subjects with a current MDE or anxiety disorders had greater severities of pain and insomnia as compared with subjects without these conditions. After controlling for demographic variables, MDE was more strongly associated with insomnia than severe low back pain; moreover, the severity of depression had a greater association with insomnia than pain intensity. Conclusion: The association of depression with insomnia was not inferior to that of pain intensity with insomnia. Among patients with CLBP and insomnia, integration of depression and anxiety treatment into treatment of pain might help to improve sleep quality.

Original languageEnglish
Pages (from-to)1993-1998
Number of pages6
JournalNeuropsychiatric Disease and Treatment
StatePublished - 16 08 2016

Bibliographical note

Publisher Copyright:
© 2016 Wang et al.


  • Anxiety
  • Backache
  • Depressive disorder
  • Insomnia
  • Sleep quality


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