PSYCHOSOCIAL FACTORS ASSOCIATED WITH CHRONIC LOW BACK PAIN AMONG ADULT UGANDANS ATTENDING THE SPINE CLINIC AT MULAGO NATIONAL REFERRAL HOSPITAL.

Abstract

Background: Chronic low back pain (CLBP) remains a leading cause of disability worldwide, disproportionately affecting populations in low-resource settings. Despite mounting evidence of its psychosocial underpinnings, there is limited context-specific research from Sub-Saharan Africa, particularly Uganda. Objective: To investigate the prevalence and influence of psychosocial and socio-cultural factors on the experience and severity of CLBP among adult Ugandan patients attending the spine clinic at Mulago National Referral Hospital. Methods: This cross-sectional mixed-methods study involved 422 adults with CLBP. Quantitative data were collected using validated tools including the DASS-21, Pain Catastrophizing Scale (PCS), Fear Avoidance Beliefs Questionnaire (FABQ), and the Oswestry Disability Index (ODI). Qualitative data were obtained through semi-structured interviews and analyzed thematically. Statistical analyses included descriptive summaries and Spearman correlation tests. Results: A high prevalence of severe to extremely severe anxiety (83.6%), depression (44.9%), and stress (28.1%) was observed. Significant positive correlations were found between psychosocial variables and disability severity (ODI scores): anxiety (ρ = 0.61), depression (ρ = 0.58), stress (ρ = 0.55), PCS (ρ = 0.65), and FABQ (ρ = 0.57), all p < 0.001. Participants with high perceived social support had significantly lower disability scores than those with low support (p < 0.001). Qualitative findings revealed four core themes: anxiety-induced activity avoidance, medication dependency, emotional instability, and sleep disruption. Cultural and spiritual beliefs also influenced coping and treatment-seeking behavior. Conclusion: This study reinforces the importance of adopting a biopsychosocial approach to CLBP management in Uganda. Psychological distress and limited social support significantly exacerbate v pain-related disability, while cultural beliefs shape health behaviors. Addressing these factors through multidisciplinary, culturally responsive care models is essential for improving outcomes. Keywords: Chronic low back pain, psychosocial factors, disability, Uganda, social support, biopsychosocial model