Depressive symptoms as a risk factor for disabling back pain in community-dwelling older persons

Objectives: To determine whether the presence of depressive symptoms is an independent risk factor for disabling back pain in community-dwelling older persons. Design: Prospective cohort study with a 12-month follow-up period. Setting: General community. Participants: Seven hundred forty-four members of a large health plan who were aged 70 and older and independent in bathing, walking, dressing, and transferring at baseline. Measurements: The presence of depressive symptoms, defined as a score of 16 or greater on the Center for Epidemiologic Studies-Depression Scale, was documented during a comprehensive baseline assessment that also included information regarding participants' demographic, medical, and physical/cognitive status. The occurrence of disabling back pain was ascertained during monthly telephone interviews. Results: Depressive symptoms were present in 153 (20.6%) participants at baseline. Over the 12-month follow-up period, 186 participants (25.0%) reported disabling back pain during 1 to 2 months and 91 (12.2%) during 3 or more months. After adjustment for potential confounders, the presence of depressive symptoms was independently associated with the occurrence of disabling back pain (adjusted odds ratio (AOR)=2.3 (95% confidence interval (CI)=1.2-4.4) for 1 to 2 months with disabling back pain; AOR=7.8 (95% CI=3.7-16.4) for 3 or more months with disabling back pain). Conclusion: The presence of depressive symptoms is a strong, independent, and highly prevalent risk factor for the occurrence of disabling back pain in community-dwelling older persons.