Angstman Kurt B, Bansal Shalu, Chappell Daniel H, Bock F Andrew, Rasmussen Norman H
Department of Family Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002, USA.
J Am Osteopath Assoc. 2013 Jul;113(7):530-7. doi: 10.7556/jaoa.2013.004.
Depression and low back problems are common issues in primary care.
To compare 6-month depression outcomes (specifically, clinical results and number of outpatient visits) in patients with or without comorbid low back conditions (LBCs). The authors hypothesized that the presence of an LBC within 3 months of the diagnosis of depression would negatively affect clinical outcomes of depression treatment after 6 months.
Retrospective record review.
Collaborative care management program in a large primary care practice.
Patients with a diagnosis of depression enrolled in collaborative care management (N=1326), including 172 with and 1154 without evidence of an LBC within 3 months of enrollment.
Clinical depression outcomes (remission and persistent depressive symptoms) and number of outpatient visits at 6 months.
Regression modeling for clinical remission and persistent depressive symptoms at 6 months demonstrated that LBCs were not an independent factor affecting clinical remission (P=.24) but were associated with persistent depressive symptoms (odds ratio, 1.559; 95% confidence interval, 1.065-2.282; P=.02); LBCs remained an independent predictor of outlier status for outpatient visits (≥8 clinical visits after 6 months of enrollment), with an odds ratio of 1.581 (95% confidence interval, 1.086-2.30; P=.02).
Increased odds of persistent depressive symptoms and increased number of outpatient visits were found in patients with depression and concomitant LBCs 6 months after enrollment into collaborative care management, compared with those in patients with depression and without LBCs. The data suggest that temporally related LBCs could lead to worse outcomes in primary care patients being treated for depression, encouraging closer observation and possible therapeutic changes in this cohort.
抑郁症和腰背痛问题是初级保健中的常见问题。
比较合并或未合并腰椎疾病（LBCs）的患者6个月时的抑郁结局（具体而言，临床结果和门诊就诊次数）。作者假设在抑郁症诊断后3个月内存在LBCs会对6个月后抑郁症治疗的临床结果产生负面影响。
回顾性记录审查。
大型初级保健机构中的协作护理管理项目。
参与协作护理管理的抑郁症诊断患者（N = 1326），其中172例在入组后3个月内有LBCs证据，1154例无LBCs证据。
6个月时的临床抑郁结局（缓解和持续性抑郁症状）以及门诊就诊次数。
对6个月时临床缓解和持续性抑郁症状的回归模型显示，LBCs不是影响临床缓解的独立因素（P = 0.24），但与持续性抑郁症状相关（优势比，1.559；95%置信区间，1.065 - 2.282；P = 0.02）；LBCs仍然是门诊就诊异常状态（入组6个月后≥8次临床就诊）的独立预测因素，优势比为1.581（95%置信区间，1.086 - 2.30；P = 0.02）。
与无LBCs的抑郁症患者相比，入组协作护理管理6个月后，合并LBCs的抑郁症患者持续性抑郁症状的几率增加，门诊就诊次数增多。数据表明，时间上相关的LBCs可能导致接受抑郁症治疗的初级保健患者出现更差的结局，这促使对该队列进行更密切的观察和可能的治疗调整。
