title: Effects of concurrent low back conditions on depression outcomes.
abstract: BACKGROUND
  Depression and low back problems are common issues in primary care.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  Retrospective record review.
  
  
  METHODS
  Collaborative care management program in a large primary care practice.
  
  
  METHODS
  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.
  
  
  METHODS
  Clinical depression outcomes (remission and persistent depressive symptoms) and number of outpatient visits at 6 months.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Family Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002, USA. angstman.kurt@mayo.edu
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Angstman
authors.forename: Shalu
authors.initials: S
authors.lastname: Bansal
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Chappell
authors.forename: F Andrew
authors.initials: FA
authors.lastname: Bock
authors.forename: Norman H
authors.initials: NH
authors.lastname: Rasmussen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D006801:Humans; D017116:Low Back Pain / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011320:Primary Health Care; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult