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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 5/2022

01-04-2022 | Mood Disorders | Systematic Review

Association Between Depressive Symptoms or Depression and Health Outcomes for Low Back Pain: a Systematic Review and Meta-analysis

Authors: Jessica J. Wong, DC, MPH, Andrea C. Tricco, MSc, PhD, Pierre Côté, DC, PhD, Catherine Y. Liang, MPH, Jeremy A. Lewis, BA, Zachary Bouck, MPH, Laura C. Rosella, MHSc, PhD

Published in: Journal of General Internal Medicine | Issue 5/2022

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Abstract

Background

Study results vary on whether depressive symptoms are associated with worse prognosis for low back pain (LBP). We assessed the association between depressive symptoms or depression and health outcomes in persons with LBP.

Methods

We searched MEDLINE, Embase, CINAHL, and PsycINFO from inception to June 2020. Eligible studies were cohort and case-control studies assessing the association between depressive symptoms (questionnaires) or depression (diagnoses) and health outcomes in persons aged ≥16 years with LBP in the absence of major pathology. Reviewers independently screened articles, extracted data, and assessed risk of bias using the Quality in Prognosis Studies tool. We classified exploratory versus confirmatory studies based on phases of prognostic factor investigation. We conducted random-effects meta-analyses and descriptive synthesis where appropriate.

Results

Of 13,221 citations screened, we included 62 studies (63,326 participants; 61 exploratory studies, 1 confirmatory study). For acute LBP, depressive symptoms were associated with self-reported disability (descriptive synthesis: 6 studies), worse recovery (descriptive synthesis: 5 studies), and slower traffic injury–related claim closure (1 study), but not pain or work-related outcomes. Depressive symptoms were associated with greater primary healthcare utilization for acute LBP (1 confirmatory study). For chronic LBP, depressive symptoms were associated with higher pain intensity (descriptive synthesis: 9 studies; meta-analysis: 3 studies, 2902 participants, β=0.11, 95% confidence interval (CI) 0.05–0.17), disability (descriptive synthesis: 6 studies; meta-analysis: 5 studies, 3549 participants, β=0.16, 95% CI 0.04–0.29), and worse recovery (descriptive synthesis: 2 studies; meta-analysis: 2 studies, 13,263 participants, relative risk (RR)=0.91, 95% CI 0.88–0.95), but not incident chronic widespread pain (1 study).

Discussion

Depressive symptoms may be associated with self-reported disability and worse recovery in persons with acute and chronic LBP, and greater primary healthcare utilization for acute LBP. Our review provides high-quality prognostic factor information for LBP. Healthcare delivery that addresses depressive symptoms may improve disability and recovery in persons with LBP. Confirmatory studies are needed to assess the association between depressive symptoms and health outcomes in persons with LBP.

Protocol Registration

PROSPERO database (CRD42019130047)
Appendix
Available only for authorised users
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Metadata
Title
Association Between Depressive Symptoms or Depression and Health Outcomes for Low Back Pain: a Systematic Review and Meta-analysis
Authors
Jessica J. Wong, DC, MPH
Andrea C. Tricco, MSc, PhD
Pierre Côté, DC, PhD
Catherine Y. Liang, MPH
Jeremy A. Lewis, BA
Zachary Bouck, MPH
Laura C. Rosella, MHSc, PhD
Publication date
01-04-2022
Publisher
Springer International Publishing
Published in
Journal of General Internal Medicine / Issue 5/2022
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-021-07079-8

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