More data on major depression as an antecedent risk factor for first onset of chronic back pain

Background. Few epidemiological studies have examined the temporal relationship between chronic pain and depression using longitudinal data. In the present study, we examined major depression as both an antecedent risk factor and consequence of chronic back pain (CBP) in the general population. Method. Data on 9909 pain-free individuals 15 years and older with no history of back problems were drawn from cycle I of the National Population Health Survey and followed up 24 months later. Major depression was assessed using a structured diagnostic interview. Results. At cycle 2, the rate of new cases of CBP in persons who were depressed at cycle I was 3.6% compared to 1.1% in non-depressed persons. Compared to pain-free individuals, new cases of CBP were more likely to perceive their health status as poor or fair at cycle 1, were less likely to be working, reported more chronic health problems, and sustained a back or neck injury in the preceding 12 months. After controlling for other factors, pain-free individuals diagnosed as major depressed at cycle I were almost three times more likely (OR 2.9, 95% Cl 1.2-7.0) to develop CBP at cycle 2. Conclusions. Consistent with other longitudinal studies major depression increases the risk of developing future chronic pain. The causal mechanism linking these conditions is unknown however depression may represent a modifiable risk factor in the development of CBP.