The impact of depression among chronic low back pain patients in Japan

• Published in: BMC musculoskeletal disorders Vol. 17; no. 1; p. 447
• Main Authors: Tsuji, Toshinaga, Matsudaira, Ko, Sato, Hiroki, Vietri, Jeffrey
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 27.10.2016; BioMed Central
• Subjects: Absenteeism; Adult; Aged; Back pain; Care and treatment; Chronic pain; Chronic Pain - economics; Chronic Pain - psychology; Comorbidity; Cost of Illness; Depression - economics; Depression - etiology; Depression, Mental; Diagnosis; Disability; Dopamine; Efficiency; Female; Generalized linear models; Health Surveys; Humans; Japan; Low back pain; Low Back Pain - economics; Low Back Pain - psychology; Male; Mental depression; Middle Aged; Musculoskeletal diseases; Pain Measurement; Patients; Productivity; Psychological aspects; Quality of Life; Questionnaires; Japan; United States > US; Depression; Chronic low back pain; Low back pain; Quality of life
• ISSN: 1471-2474; 1471-2474
• DOI: 10.1186/s12891-016-1304-4

Chronic low back pain (CLBP) is associated with significant disability and reductions in health related quality of life (HRQoL), which can negatively impact overall function and productivity. Depression is also associated with painful physical symptoms, and is often present in patients with chronic pain. However, the incremental burden associated with depression or symptoms of depression among CLBP patients is not well understood. The objective of this study was to investigate the impact of depression on HRQoL in CLBP and to assess the relationship between depression and work impairment and healthcare use among CLBP patients in Japan. Data were extracted from the 2014 Japan National Health and Wellness Survey (N = 30,000). CLBP was defined by report of diagnosed low back pain ≥3 months duration. Depression was assessed using the Patient Health Questionnaire (PHQ-9). Measurements assessed included pain, HRQoL, labor force participation, work productivity and healthcare utilization. Patients with depression (PHQ-9 ≥ 10) were compared to patients without depression (PHQ-9 < 10) using t-tests for continuous and count variables and chi-square for categorical variables, which were followed by generalized linear models adjusted for covariates. The association between presenteeism and other patient outcomes and characteristics was analysed using nonparametric correlations (Spearman's rho). Depressed CLBP patients had significantly more severe pain and higher levels of pain compared with patients without depression (P < 0.001). Depression was associated with worse HRQoL in CLBP patients. Presenteeism, overall work impairment and activity impairment were 1.8, 1.9 and 1.7 times as high, respectively, among those with depression relative to those without depression. CLBP patients with depression had almost twice as many healthcare provider visits in 6 months than those without depression. The pattern of results remained consistent after adjustment for sociodemographic and general health characteristics. Analysis also indicated presenteeism was closely related to overall work impairment (rho = 0.99). Depression among CLBP patients in Japan was associated with higher pain scores and lower HRQoL scores, as well as lower labor productivity and increased healthcare use. Screening for depression in CLBP patients should be an essential part of CLBP patient care.