Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study

Matt Fernandez, Lucia Colodro-Conde, Jan Hartvigsen, Manuela L Ferreira, Kathryn M Refshauge, Marina B. Pinheiro, Juan R Ordoñana, Paulo H Ferreira

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

BACKGROUND CONTEXT: Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal relationships.

PURPOSE: This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors.

STUDY DESIGN: This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain.

PATIENT SAMPLE: The patient sample included 1,269 adult twins with a mean age of 53 years.

OUTCOME MEASURES: The outcome of depression or anxiety symptoms was evaluated with EuroQol questionnaire.

METHODS: Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which was partially (dizygotic [DZ] twins) and fully (monozygotic [MZ] twins) adjusted for shared familial factors. There was no external funding for this study and no conflict of interest was declared.

RESULTS: There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.34-2.44). After adjusting for confounders, the association remained significant (OR: 1.43, 95% CI: 1.05-1.95), although the adjusted co-twin case-control was non-significant in DZ (OR: 1.03, 95% CI: 0.50-2.13) and MZ twins (OR: 1.86, 95% CI: 0.63-5.51).

CONCLUSIONS: The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.

Original languageEnglish
JournalSpine Journal
Volume17
Issue number7
Pages (from-to)905-912
ISSN1529-9430
DOIs
Publication statusPublished - Jul 2017

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Twin Studies
Low Back Pain
Longitudinal Studies
Depression
Odds Ratio
Confidence Intervals
Monozygotic Twins
Dizygotic Twins
Conflict of Interest
Registries
Logistic Models
Regression Analysis

Keywords

  • Journal Article

Cite this

Fernandez, M., Colodro-Conde, L., Hartvigsen, J., Ferreira, M. L., Refshauge, K. M., Pinheiro, M. B., ... Ferreira, P. H. (2017). Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study. Spine Journal, 17(7), 905-912. https://doi.org/10.1016/j.spinee.2017.02.009
Fernandez, Matt ; Colodro-Conde, Lucia ; Hartvigsen, Jan ; Ferreira, Manuela L ; Refshauge, Kathryn M ; Pinheiro, Marina B. ; Ordoñana, Juan R ; Ferreira, Paulo H. / Chronic low back pain and the risk of depression or anxiety symptoms : insights from a longitudinal twin study. In: Spine Journal. 2017 ; Vol. 17, No. 7. pp. 905-912.
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abstract = "BACKGROUND CONTEXT: Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal relationships.PURPOSE: This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors.STUDY DESIGN: This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain.PATIENT SAMPLE: The patient sample included 1,269 adult twins with a mean age of 53 years.OUTCOME MEASURES: The outcome of depression or anxiety symptoms was evaluated with EuroQol questionnaire.METHODS: Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which was partially (dizygotic [DZ] twins) and fully (monozygotic [MZ] twins) adjusted for shared familial factors. There was no external funding for this study and no conflict of interest was declared.RESULTS: There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis (odds ratio [OR]: 1.81, 95{\%} confidence interval [CI]: 1.34-2.44). After adjusting for confounders, the association remained significant (OR: 1.43, 95{\%} CI: 1.05-1.95), although the adjusted co-twin case-control was non-significant in DZ (OR: 1.03, 95{\%} CI: 0.50-2.13) and MZ twins (OR: 1.86, 95{\%} CI: 0.63-5.51).CONCLUSIONS: The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.",
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Fernandez, M, Colodro-Conde, L, Hartvigsen, J, Ferreira, ML, Refshauge, KM, Pinheiro, MB, Ordoñana, JR & Ferreira, PH 2017, 'Chronic low back pain and the risk of depression or anxiety symptoms: insights from a longitudinal twin study', Spine Journal, vol. 17, no. 7, pp. 905-912. https://doi.org/10.1016/j.spinee.2017.02.009

Chronic low back pain and the risk of depression or anxiety symptoms : insights from a longitudinal twin study. / Fernandez, Matt; Colodro-Conde, Lucia; Hartvigsen, Jan; Ferreira, Manuela L; Refshauge, Kathryn M; Pinheiro, Marina B.; Ordoñana, Juan R; Ferreira, Paulo H.

In: Spine Journal, Vol. 17, No. 7, 07.2017, p. 905-912.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Chronic low back pain and the risk of depression or anxiety symptoms

T2 - insights from a longitudinal twin study

AU - Fernandez, Matt

AU - Colodro-Conde, Lucia

AU - Hartvigsen, Jan

AU - Ferreira, Manuela L

AU - Refshauge, Kathryn M

AU - Pinheiro, Marina B.

AU - Ordoñana, Juan R

AU - Ferreira, Paulo H

N1 - Copyright © 2017 Elsevier Inc. All rights reserved.

PY - 2017/7

Y1 - 2017/7

N2 - BACKGROUND CONTEXT: Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal relationships.PURPOSE: This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors.STUDY DESIGN: This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain.PATIENT SAMPLE: The patient sample included 1,269 adult twins with a mean age of 53 years.OUTCOME MEASURES: The outcome of depression or anxiety symptoms was evaluated with EuroQol questionnaire.METHODS: Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which was partially (dizygotic [DZ] twins) and fully (monozygotic [MZ] twins) adjusted for shared familial factors. There was no external funding for this study and no conflict of interest was declared.RESULTS: There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.34-2.44). After adjusting for confounders, the association remained significant (OR: 1.43, 95% CI: 1.05-1.95), although the adjusted co-twin case-control was non-significant in DZ (OR: 1.03, 95% CI: 0.50-2.13) and MZ twins (OR: 1.86, 95% CI: 0.63-5.51).CONCLUSIONS: The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.

AB - BACKGROUND CONTEXT: Pain is commonly associated with symptoms of depression or anxiety, although this relationship is considered bidirectional. There is limited knowledge regarding causal relationships.PURPOSE: This study aims to investigate whether chronic low back pain (LBP) increases the risk of depression or anxiety symptoms, after adjusting for shared familial factors.STUDY DESIGN: This is a longitudinal, genetically informative study design from the Murcia Twin Registry in Spain.PATIENT SAMPLE: The patient sample included 1,269 adult twins with a mean age of 53 years.OUTCOME MEASURES: The outcome of depression or anxiety symptoms was evaluated with EuroQol questionnaire.METHODS: Using logistic regression analyses, twins were initially assessed as individuals in the total sample analysis, followed by a co-twin case-control, which was partially (dizygotic [DZ] twins) and fully (monozygotic [MZ] twins) adjusted for shared familial factors. There was no external funding for this study and no conflict of interest was declared.RESULTS: There was a significant association between chronic LBP and the risk of depression or anxiety symptoms in the unadjusted total sample analysis (odds ratio [OR]: 1.81, 95% confidence interval [CI]: 1.34-2.44). After adjusting for confounders, the association remained significant (OR: 1.43, 95% CI: 1.05-1.95), although the adjusted co-twin case-control was non-significant in DZ (OR: 1.03, 95% CI: 0.50-2.13) and MZ twins (OR: 1.86, 95% CI: 0.63-5.51).CONCLUSIONS: The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal. The relationship is likely to be explained by confounding from shared familial factors, given the non-statistically significant associations in the co-twin case-control analyses.

KW - Journal Article

U2 - 10.1016/j.spinee.2017.02.009

DO - 10.1016/j.spinee.2017.02.009

M3 - Journal article

C2 - 28267634

VL - 17

SP - 905

EP - 912

JO - The Spine Journal

JF - The Spine Journal

SN - 1529-9430

IS - 7

ER -