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Depression is Closely Associated With Chronic Low Back Pain in Patients Over 50 Years of Age

A Cross-sectional Study Using the Sixth Korea National Health and Nutrition Examination Survey (KNHANES VI-2)

Park, Sang-Min, MD; Kim, Ho-Joong, MD, PhD; Jang, Seonpyo, MD; Kim, Hyoungmin, MD; Chang, Bong-Soon, MD, PhD; Lee, Choon-Ki, MD; Yeom, Jin S., MD

doi: 10.1097/BRS.0000000000002595
Health Services Research
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Study Design. A cross-sectional study.

Objective. This study was designed to analyze the relationship between the presence and severity of depression and low back pain (LBP) in a representative sample of the general population using a self-report screening questionnaire for depression.

Summary of Background Data. There is increasing evidence supporting an association between depression and LBP. However, the degree of the association between these two conditions in the general population is poorly understood.

Methods. Health surveys and examinations were conducted on a nationally representative sample (n = 7550) of Koreans. LBP status was determined by a simple survey response concerning LBP >30 days during the past 3 months. Depression was defined as individuals with a total score >10 on the Patient Health Questionnaire (PHQ)-9 survey. The severity of depression was categorized as none (0–4), mild (5–9), moderate (10–14), moderately severe (15–19), and severe (20–27) according to PHQ-9 score. Data regarding demographics, socioeconomic history, and comorbid health conditions were used to analyze adjusted, weighted logistic regression models.

Results. In the Korean population, the prevalence of depression was significantly greater in individuals with LBP (20.3%) than in those without LBP (4.5%). On multivariate logistic regression analysis, the presence of depression was significantly associated with LBP (adjusted odd ratio [aOR]: 3.93, P < 0.001). The risk of LBP increased with increasing severity of depression as follows: severe depression (aOR: 9.28, P < 0.001), moderately severe depression (aOR: 3.24, P = 0.001), moderate depression (aOR: 4.97, P < 0.001), and mild depression (aOR: 2.48, P < 0.001).

Conclusion. Depression is more common in patients with LBP among Koreans. The presence of depression was significantly associated with LBP, especially in severely depressed individuals.

Level of Evidence: 3

Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, Sungnam, Republic of Korea

Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Hospital, Seoul, Korea.

Address correspondence and reprint requests to Jin S. Yeom, MD, Spine Center and Department of Orthopaedic Surgery, Seoul National University College of Medicine and Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do 13620, Republic of Korea; E-mail: highcervical@gmail.com

Received 4 October, 2017

Revised 3 January, 2018

Accepted 24 January, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

No relevant financial activities outside the submitted work.

Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.