title: The relationship of unemployment and depression with history of spine surgery.
abstract: BACKGROUND
  Chronic back pain is a known risk factor for unemployment, disability, and depression. This paper discusses the interaction of unemployment, depression, and history of prior spine surgery.
  
  
  METHODS
  We retrospectively reviewed the charts of 629 patients who underwent spine surgery and who were between the ages of 25 and 65 years. We collected data on their employment status, history of depression, and history of prior spine surgery (yes or no). Three types of spine surgery were included in the study: lumbar microdiscectomy, anterior cervical decompression and fusion, and lumbar decompression and fusion.
  
  
  RESULTS
  Approximately 29% (183) of the patients were unemployed and 32% (200) had a history of depression. Unemployment was more common among depressed patients (44% vs 27%; p < 0.001), and depression was more common among unemployed patients (41% vs 24%; p < 0.001). A history of prior spine surgery was most prevalent in unemployed female patients with a history of depression.
  
  
  CONCLUSIONS
  Unemployment and depression were strongly associated with a history of prior spine surgery in the female cohort of our study population.
authors.forename: M Sami
authors.initials: MS
authors.lastname: Walid
authors.forename: Nadezhda
authors.initials: N
authors.lastname: Zaytseva