Analysis of risk factors for depression among patients with chronic low back pain in an orthopaedic clinic of a Nigerian teaching hospital

BACKGROUND: Depression compounds the burden of chronic low back pain and has implications on the outcome of treatment. Published reports demonstrated a strong association between depression and chronic low back pain. However, there is very scanty data on predisposing factors for depression among these patients. OBJECTIVE: To determine the risk factors for depression among patients with chronic low back pain in a Nigerian orthopaedic clinic setting. METHOD: Three hundred (300) eligible, consenting and consecutive patients with chronic low back pain in orthopaedic clinic of Federal Teaching Hospital Abakaliki Nigeria were interviewed with Population and Pain Characteristics Questionnaire, General Health Questionnaire (GHQ-12) and Major Depressive Episode of Mini-International Neuropsychiatric Interview (M.I.N.I) over a period of 34 months. Statistically significant factors that emerged from Pearson chi-square test of association were entered into logistic regression analysis to evaluate the risk of each factor when adjusted to other factors. Depression was observed in 61(20.3%) of the patients interviewed. Seven factors for depression among these patients emerged from chi square test of association. Logistic regression analysis identified alcohol consumption, severe pain intensity, hypertension co-morbidity and prior traditional healer care as the independent risk factors for depression among the patients. CONCLUSION: The independent risk factors for depression identified in this study calls for maintaining a high level of suspicion in the patients with these risk factors to facilitate early recognition of depression, and a high priority accorded to them in the measures aimed at addressing depression for a good therapeutic outcome.