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Three-question depression screener used for lumbar disc herniations and spinal stenosis
Howard I Levy1, Brett Hanscom, Scott D Boden
1Emory Spine Center, Emory University School of Medicine, Decatur, Georgia, USA.
Study Design:
A depression screener was used to determine positive responses amongst patients with two disorders commonly treated with surgery.
Objective:
To examine the relation between positive responses to the depression screener and pain characteristics, sociodemographic responses, and Short-Form 36-Item Health Survey subscale scores among patients with lumbar disc herniation or spinal stenosis.
Summary Of Background Data:
Numerous studies have reported a correlation between depression and low back pain, but few have examined this relation among patients with a diagnosis of sciatica from lumbar disc herniation or spinal stenosis. The Health Status Questionnaire 2.0 includes both the Short-Form 36-Item Health Survey (a validated, multidimensional, generic instrument measuring health-related quality of life and functional status) and the three-question depression screener.
Methods:
The database of the National Spine Network (a nonprofit collaboration of physicians caring for patients with back and neck problems that pools patient data) was queried for patients 18 to 65 years of age with a diagnosis of lumbar disc herniation (n = 2878) and patients 30 to 80 years of age with a diagnosis of spinal stenosis (n = 3801). Depression screeners scored positive when patients reported depressive symptoms within the year to any question about symptoms.
Results:
The screener elicited positive responses from 36.4% of the patients with spinal stenosis and 38.4% of the patients with lumbar disc herniation. Among the patients with spinal stenosis or lumbar disc herniation, those with positive depression screener responses reported longer duration of symptoms (>7 weeks) and failure to improve. They were more likely to be obese, recipients of workers' compensation, unmarried, and less educated (below Grade 12). In multivariate analyses, positive depression screener responses were significantly associated with an attorney's services and a longer duration of symptoms.
Conclusions:
A positive depression screener response is strongly associated with poorer functional status and health-related quality of life, as measured by the Short-Form 36-Item Health Survey, among patients with lumbar disc herniation or spinal stenosis, and higher symptom intensity.