Aims: To study the frequency of major depressive disorder, assess sleep quality, permanent functional disability and association of major depressive disorder with the permanent disability, quality of life and quality of sleep in patients of chronic low backache. Materials and Methods: Hundred consecutive patients visiting orthopedic OPD with chronic low backache in a tertiary hospital were included, patients with a past history of psychiatric illness were excluded. The interview was taken for diagnosis of major depressive disorder using DSM 5 and assessed for severity of depression, health-related quality of life and sleep quality by Hamilton depression rating scale, SF 36 health questionnaire, Pittsburg Quality of Sleep Index respectively. The proportion was compared by using chi-square test, scores of scales were compared using Mann Whitney test and Kruskal-Wallis test followed by Dunn’s post-hoc multiple comparisons. Statistical data were analyzed by Graph Pad InStat version 3.06. (San Diego, California, US).A p value of <0.05 was considered statistically significant. Results: The frequency of major depressive disorder, poor quality of sleep in patients of chronic low backache was 74 and 81 respectively. Patients having MDD had a poorer quality of sleep, quality of life and a higher functional disability.Severe functional disability due to a low backache had severe depressive symptoms, poorer quality of sleep and life. The severity of depression is positively correlated with functional disability. Conclusions: patients with chronic low backache had a high frequency of depression, poor quality of sleep and life and higher functional disability.