Primary Health Care Research & Development


Depression and gender differences among younger immigrant patients on sick leave due to chronic back pain: a primary care study

Marina Taloyana1a2 c1 and Monica Löfvandera1a3a4

a1 Center for Family and Community Medicine, Department of Neurobiology, Caring Sciences and Society, Karolinska Institutet, Stockholm, Sweden

a2 Stress Research Institute, Stockholm University, Stockholm, Sweden

a3 Center for Clinical Research – Västmanland, Uppsala University, Västerås, Sweden

a4 Family Medicine and Preventive Medicine Unit, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden


Background Mental ill-health and pain are major causes for disability compensation in female adults in Sweden.

Aims The aims of this study were to (1) analyse gender differences in the prevalence of depression among immigrant patients with chronic back pain and (2) explore whether factors such as age, marital status, educational level, religious faith, number of children and number of diagnosed pain sites could explain these differences.

Methods The study sample consisted of 245 sick-listed primary care patients in consecutive order aged 18 through 45 years with a median duration of sick leave of 10 months for back pain and participating in a rehabilitation programme. Explanatory variables included physicians’ diagnosed pain sites, age, marital status, education, number of children and religious affiliation. Predictive factors for depression were analysed using logistic regression.

Findings The women differed significantly from the men in three aspects: they were less educated, had more children and had more multiple pain sites, that is, 68% versus 45%. In the age-adjusted model, women were twice as likely to have depression (odds ratio (OR) 2.1). Regardless the gender, those with intermediate education of 9–11 years had the lowest odds of outcome compared with those with <0–8 years and ≥12 years education. Finally, after adjusting for all explanatory variables, the ORs of depression for women decreased to a non-significant level (OR 1.8; 95% confidence interval (CI) 0.94–3.43). Furthermore, regardless of the gender, those with multiple pain sites had twice higher odds (OR 2.04; 95% CI 1.11–3.74) of depression than those with fewer pain sites.

Conclusion Gender differences in odds of depression in our study could be explained by a higher prevalence of diagnosed multiple pain sites in women. This calls for tailor-made treatments that focus on the pain relief needs of immigrant women with low education and chronic back pain.

(Received November 13 2011)

(Revised October 04 2012)

(Accepted October 14 2012)

(Online publication February 07 2013)

Key words

  • chronic back pain;
  • depression;
  • immigrants;
  • primary care;
  • somatic pain


c1 Correspondence to: Marina Taloyan, Department of Neurobiology, Center for Family and Community Medicine, Caring Sciences and Society, Karolinska Institute, Alfred Nobels allé 12, 14152 Huddinge, Sweden. Email: