Prevalence, severity, and determinants of depressive disorder among patients with low back pain in Al-Qassim Region, Saudi Arabia

Background: Low back pain (LBP) is a widespread health problem that poses a severe economic burden on both affected patients and their societies. A bidirectional relationship between depression and other chronic illnesses, including chronic LBP, has been suggested. However, the exact association between them remains unclear. Objectives: To investigate the association between depressive disorder and low back pain and its impact on disability of patients. Patients and methods: A cross-sectional study carried out in the orthopedic clinics of AlBadaya General Hospital, Qassim Region, Saudi Arabia, among a sample of patients with LBP throughout the period of the study (April-June 2024,). An interview questionnaire composed of four parts was utilized: personal information, medical history, and habits, the Arabic-validated version of the Roland-Morris Disability Questionnaire (RMDQ), and the Patient Health Questionnaire (PHQ)-9 to assess depression. Results: A total of 365 patients were included in this study. Their age ranged between 18 and 85 years, with an arithmetic mean of 47.9 and a standard deviation (SD) of 10.4 years. Females represented 55.6% of them. The overall prevalence of depressive disorder among the participants was 56.2%, being mild in 40.3% of patients and moderately severe or severe among 2.7% of them. The disability score ranged between 0 and 24 with an arithmetic mean of 10.7 and SD of 6.2, while its median 1 value was 11, and its interquartile range was 6-15.5. Patients with moderately severe/severe depression had the highest disability score (median value was 15 and the mean rank was 243.25), while those with no depression had the lowest disability score (median value was seven and mean rank was 130.62), p<0.001. Multivariate logistic regression analysis revealed that with each unit increase in disability score, there was a 20% increase in depression (Adjusted odds ratio "AOR" =1.20; 95% confidence interval "CI": 1.14-1.26), p<0.001. Conclusion: Depression is very commonly associated with chronic LBP, although it is mostly mild. Disability is a serious complication of chronic LBP, and its severity is associated with the degree of depression. Therefore, patients with chronic LBP should be screened for depression.