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These patients frequently present with co-occurrent symptoms of anxiety and\/or depression (A\/D). Return to work (RTW) is an important measure of functional recovery, but the longitudinal impact of A\/D on RTW in patients with chronic pain is less understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This study investigates the association between A\/D symptoms and RTW among sick-listed patients referred to multidisciplinary physical medicine outpatient clinics with chronic neck or back pain (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093291), using comprehensive follow-up data from Norwegian national registers. The contribution of A\/D symptoms to non-RTW was calculated using population attributable fractions (PAF), with self-reported pain intensity as reference.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of case level A\/D symptoms was 56.8%. There was an association between case level A\/D symptoms and non-RTW at 12\u00a0months both in the unadjusted model (RR 1.32, 95% CI 1.22\u20131.44) and after adjustment for sociodemographic factors and symptom severity (RR 1.12, 95% CI 1.03\u20131.23), and PAF was estimated to be 6.6% in the fully adjusted model. In a separate model with adjustment for the same variables, there were no association between pain intensity and non-RTW (RR 1.02, 95% CI 0.93\u20131.11).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results suggest that A\/D symptoms are more important than pain intensity for RTW at 12\u00a0months in sick-listed patients with chronic neck or back pain, irrespective of self-reported severity of musculoskeletal symptoms and sociodemographic factors. Approximately 7% of non-RTW cases could be attributed to case level A\/D symptoms. Addressing A\/D symptoms as part of assessment and treatment is essential to improve RTW outcomes in patients with chronic neck or back pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12891-026-10172-w","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:14:13Z","timestamp":1783606453000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The impact of anxiety\/depression symptoms on return to work in patients with chronic neck or back pain: a longitudinal cohort study from the Norwegian neck and back registry"],"prefix":"10.1186","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8256-5586","authenticated-orcid":false,"given":"Ingvild","family":"Bardal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils Abel Presteg\u00e5rd","family":"Aars","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samineh","family":"Sanatkar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon A. 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Fordyce's Behavioral Methods for Chronic Pain and Illness: Republished with Invited Commentaries. 2014."},{"issue":"1","key":"10172_CR51","doi-asserted-by":"publisher","first-page":"4","DOI":"10.1007\/s10926-023-10116-4","volume":"34","author":"H Xu","year":"2024","unstructured":"Xu H, Cai J, Sawhney R, Jiang S, Buys N, Sun J. The effectiveness of cognitive-behavioral therapy in helping people on sick leave to return to work: a systematic review and meta-analysis. J Occup Rehabil. 2024;34(1):4\u201336. https:\/\/doi.org\/10.1007\/s10926-023-10116-4.","journal-title":"J Occup Rehabil"}],"container-title":["BMC Musculoskeletal Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12891-026-10172-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-026-10172-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12891-026-10172-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T03:26:57Z","timestamp":1791343617000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12891-026-10172-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,9]]},"references-count":51,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["10172"],"URL":"https:\/\/doi.org\/10.1186\/s12891-026-10172-w","relation":{},"ISSN":["1471-2474"],"issn-type":[{"value":"1471-2474","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,9]]},"assertion":[{"value":"8 March 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"30 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Regional Ethics Committee North (REC North), grant number #13859. Approval to obtain data from outpatient clinics was sought and confirmed from the NNRR council April 7, 2022. Approval for data from NAV was sought and confirmed January 24, 2023, (approval number #22\/18149). Linkage procedure was conducted in accordance with Norwegian General Data Protection Regulation requirements. As a part of inclusion to the registry, all participants in the NNRR consent to their data being used for scientific purposes [\n                      \n                      ], and informed consent to participate was obtained from all of the participants in the study.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"834"}}