“…Reciprocal relations among anxiety, distress, strain, depression and sleep disturbances have been suggested earlier [4,6,30,56]. These psychological symptoms are closely linked to obesity, smoking and physical inactivity [14,17,22,35,43,51,53], which have been suggested as risk factors for neck, shoulder and low back pains in adolescence [5,25,31,32,42]. Our findings that insufficient quantity or quality of sleep increases the risk of neck and low back pains independently of depressive mood, physical activity, sedentary behavior, smoking, BMI and parents' socioeconomic status may indicate that it has a mediating effect, explaining the relationship between social pressures, psychological symptoms and musculoskeletal pains.…”