Interrelationship between depression and low back pain-related disability among patients seen at orthopedic clinics in Al Qassim region,Saudi Arabia: Prevalence,severity,and determinants

Abstract

Objectives

Low back pain (LBP) is a widespread health problem that poses a severe economic burden on both affected patients and the societies in which they live. The purpose of this study was to examine the association between depression and low back pain among patients seen at an orthopedic clinic and determine the association with physical disability.

Methods

A cross-sectional study was carried out in the orthopedic clinics of Al-Badaya General Hospital in the Qassim Region, Saudi Arabia. All patients with LBP seen in the clinic between April and June 2024 were included in the study. A questionnaire was administered that collected demographic information, asked about medical history and behaviors, and included the Arabic-validated version of the Roland-Morris Disability Questionnaire (RMDQ) and the Patient Health Questionnaire (PHQ-9; depression). Multivariate logistic regression analysis was performed to identify correlates of depression.

Results

A total of 365 patients were included in the study. Age ranged between 18 and 85 years, with a mean of 47.9 years (55.6% female). The overall prevalence of depression was 56.2%; 40.3% was mild, 13.2% moderate, and 2.7% moderately severe or severe based on PHQ-9 cutoff scores. Patients with moderately severe/severe depression had the highest disability score, while those with no depression had the lowest disability score. Multivariate logistic regression analysis revealed that with each unit increase in disability score, there was a 20% increase in depression (adjusted odds ratio = 1.20, 95% CI = 1.14-1.26, P < 0.001).

Conclusion

Depression, although mostly mild, was common in this clinic sample of orthopedic patients with chronic LBP and was frequently associated with disability. Disability can be a serious complication of chronic LBP and is often closely linked with depression. As a result, patients with chronic LBP seen at orthopedic clinics in Saudi Arabia (and likely other Middle Eastern countries) should be screened for depression and managed accordingly.