Short- and Mid-Term Effectiveness of Primary and Secondary Prevention of Comorbid Depressive Symptoms among Patients with Chronic Low Back Pain

Background Because of high rates of comorbid mental disorders among patients with chronic low back pain, an intervention for pain competence and depression prevention for multidisciplinary inpatient rehabilitation was newly developed and evaluated concerning depressive symptoms, anxiety and pain related parameters. Methods Per protocol regression analyses with data of n = 723 patients were conducted to evaluate the intervention. Intraindividual changes were quantified by Cohen's d based on repeated measures analyses of variance. The results of the regression analyses were validated by n = 1306 multiple imputed data. Results Patients benefited in all analyzed parameters in the short-and mid-term (6 months after intervention) from the rehabilitation with as well as without supplemental depression prevention training. Depressive symptoms in the beginning of the rehabilitation were a significant predictor for all analyzed parameters. Additionally, the depression prevention training reduced the lowest pain intensity in the short-term independent from depressive symptoms. The results were confirmed by analyses with multiple imputations. However, improvements declined especially in depressive symptoms and anxiety in the months after rehabilitation. Discussion The results support the influence of depressive symptoms on psychological and pain related parameters, which emphasizes the relevance of an early treatment of depressive symptoms. Though, the supplemental depres-sion prevention training had no additional effect in the inpatient rehabilitation setting, which could be explained by the high effect sizes of the sole pain competence training. Moreover, beneficial effects should be supported by aftercare, because effects declined during the 6 months after rehabilitation.