Skip to main content
Log in

The prevalence of depression in degenerative spine disease patients: A systematic review and meta-analysis

  • Review Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

To estimate the prevalence of depression in degenerative spine disease (DSD) patients.

Methods

The PubMed, EMBASE, and PsycINFO were systematically searched, the relevant studies that reported the depression prevalence of in DSD patients were identified. Data were extracted independently by 2 reviewers. Subgroup analysis and sensitivity analysis were also performed.

Results

24 articles met the inclusion criteria and were selected for the current study. The pooled prevalence estimate of depression in DSD patients before operative treatment was 30.8% [95% CI 24.0–38.5%]. Nine articles reported the prevalence rate in DSD patients after operative treatment, and the pooled prevalence estimate was 27.0% [95% CI 19.9–35.4%]. There were significant differences for prevalence estimates before operative treatment in types of disorders (Q = 4.56, P = 0.10), spine surgery history (Q = 5.55, P = 0.02), representativeness of sample (Q = 11.00, P = 0.00), and validity of assessment method (Q = 3.32, P = 0.07). The prevalence estimates in patients with lumbar spine stenosis, lumbar disc herniation and cervical spondylotic myelopathy were 24.0%, 40.9% and 37.3%, respectively. Studies that included patients with a history of spine surgery yielded a more extreme prevalence estimate than studies excluding those (36.9% vs 24.3%). For results of patients after operative treatment, significant differences for prevalence estimates were showed in different degrees of pain (Q = 4.72, P = 0.03), screening instruments (Q = 4.83, P = 0.09), and representativeness of sample (Q = 15.70, P = 0.00).

Conclusion

The systematic review indicated increased prevalence of depression in DSD patients. In consideration of the relationship between depression and poor surgical outcome, we should pay more attention to identifying strategies for preventing and treating depression in DSD patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Clarençon F, Law-Ye B, Bienvenot P, Cormier É, Chiras J (2016) The Degenerative spine. Magn Reson Imaging Clin N Am 24:495–513. https://doi.org/10.1016/j.mric.2016.04.008

    Article  PubMed  Google Scholar 

  2. Gallucci M, Limbucci N, Paonessa A, Splendiani A (2007) Degenerative disease of the spine. Neuroimaging Clin N Am 17:87–103. https://doi.org/10.1016/j.nic.2007.01.002

    Article  PubMed  Google Scholar 

  3. IsHak WW, Wen RY, Naghdechi L, Vanle B, Dang J, Knosp M, Dascal J, Marcia L, Gohar Y, Eskander L, Yadegar J, Hanna S, Sadek A, Aguilar-Hernandez L, Danovitch I, Louy C (2018) Pain and depression: a systematic review. Harv Rev Psychiatry 26:352–363. https://doi.org/10.1097/HRP.0000000000000198

    Article  PubMed  Google Scholar 

  4. Bair MJ, Wu J, Damush TM, Sutherland JM, Kroenke K, Bair MJ (2008) Association of depression and anxiety alone and in combination with chronic musculoskeletal pain in primary care patients. Psychosom Med 70:890–897. https://doi.org/10.1097/PSY.0b013e318185c510

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Asdrubal F, Orlando RN, Alisson RT (2009) Avaliação clínica e funcional no pré-operatório de doenças degenerativas da coluna vertebral Evaluación clínica y funcional en el preoperatorio de patologías degenerativas de columna Clinical and functional evaluation in preoperative period of degenerative disease spine surgery. Coluna 8:245–253. https://doi.org/10.1590/S1808-18512009000300002

    Article  Google Scholar 

  6. Falavigna A, Righesso O, Teles A, Conzati L, Bossardi J, Silva P, Cheng J (2015) Responsiveness of depression and its influence on surgical outcomes of lumbar degenerative diseases. Eur J Orthop Surg Traumatol 25:35–41. https://doi.org/10.1007/s00590-015-1651-0

    Article  Google Scholar 

  7. Lebow R, Parker SL, Adogwa O, Reig A, Cheng J, Bydon A, Mcgirt MJ, Lebow R (2012) Microdiscectomy improves pain-associated depression, somatic anxiety, and mental well-being in patients with herniated lumbar disc. Neurosurgery 70:306–311. https://doi.org/10.1227/NEU.0b013e3182302ec3

    Article  PubMed  Google Scholar 

  8. Salk RH, Hyde JS, Abramson LY (2017) Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull 143:783–822. https://doi.org/10.1037/bul0000102

    Article  PubMed  PubMed Central  Google Scholar 

  9. Hébert JJ, Abraham E, Wedderkopp N, Bigney E, Richardson E, Darling M, Hall H, Fisher CG, Rampersaud YR, Thomas KC, Jacobs WB, Johnson M, Paquet J, Attabib N, Jarzem P, Wai EK, Rasoulinejad P, Ahn H, Nataraj A, Stratton A, Manson N, Hébert JJ (2020) Preoperative factors predict postoperative trajectories of pain and disability following surgery for degenerative lumbar spinal stenosis. Spine 45:E1421–E1430. https://doi.org/10.1097/BRS.0000000000003587

    Article  PubMed  PubMed Central  Google Scholar 

  10. Wagner A, Shiban Y, Wagner C, Aftahy K, Joerger AK, Meyer B, Shiban E (2020) Psychological predictors of quality of life and functional outcome in patients undergoing elective surgery for degenerative lumbar spine disease. Eur Spine J 29:349–359. https://doi.org/10.1007/s00586-019-06106-x

    Article  PubMed  Google Scholar 

  11. Parlato C, Iavarone A, Gentile M, Albanese R, Moraci A (2013) Outcome of lumbar intervertebral foraminal stenosis surgery and depression. Eur Neurol 69:304–308. https://doi.org/10.1159/000346216

    Article  CAS  PubMed  Google Scholar 

  12. Wahlman M, Häkkinen A, Dekker J, Marttinen I, Vihtonen K, Neva M (2014) The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion. Eur Spine J 23:129–134. https://doi.org/10.1007/s00586-013-2896-0

    Article  PubMed  Google Scholar 

  13. Arpino L, Iavarone A, Parlato C, Moraci A (2004) Prognostic role of depression after lumbar disc surgery. Neurol Sci 25:145–147. https://doi.org/10.1007/s10072-004-0248-x

    Article  CAS  PubMed  Google Scholar 

  14. Stang A (2010) Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol 25:603–605. https://doi.org/10.1007/s10654-010-9491-z

    Article  Google Scholar 

  15. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327:557–560. https://doi.org/10.1136/bmj.327.7414.557

    Article  PubMed  PubMed Central  Google Scholar 

  16. Higgins JPT, Thompson SG, Deeks JJ, Berlin JA, Rothwell PM (2002) Quantifying heterogeneity in a meta-analysis. STAT MED 21:1539–1558. https://doi.org/10.1002/sim.1186

    Article  PubMed  Google Scholar 

  17. Parker SL, Zuckerman SL, Shau DN, Mendenhall SK, Godil SS, Mcgirt MJ (2012) Extent of preoperative depression is associated with return to work after lumbar fusion for spondylolisthesis. The spine journal 12:S119–S120. https://doi.org/10.1016/j.spinee.2012.08.321

    Article  Google Scholar 

  18. Junge A, Dvorak J, Ahrens S, Junge A (1995) Predictors of bad and good outcomes of lumbar disc surgery. A prospective clinical study with recommendations for screening to avoid bad outcomes. Spine 20:460–468

    Article  CAS  Google Scholar 

  19. Stoffman MR, Roberts MS, King JT, Stoffman MR (2005) Cervical spondylotic myelopathy, depression, and anxiety: a cohort analysis of 89 patients. Neurosurgery 57:307–313. https://doi.org/10.1227/01.NEU.0000166664.19662.43

    Article  PubMed  Google Scholar 

  20. Levy HI, Hanscom B, Boden SD, Levy HI (2002) Three-question depression screener used for lumbar disc herniations and spinal stenosis. Spine 27:1232–1237. https://doi.org/10.1097/00007632-200206010-00017

    Article  PubMed  Google Scholar 

  21. Hsu HC, Chang CJ, Tung HH, Wang TJ (2019) Disability, emotional distress, and well-being among patients with lumbar spondylolisthesis. J Clin Nurs 28:3866–3878. https://doi.org/10.1111/jocn.14992

    Article  PubMed  Google Scholar 

  22. Gilmore SJ, Hahne AJ, Davidson M, McClelland JA (2019) Predictors of substantial improvement in physical function six months after lumbar surgery: is early post-operative walking important? A prospective cohort studies. BMC Musculoskel Dis. https://doi.org/10.1186/s12891-019-2806-7

    Article  Google Scholar 

  23. Chenchen Z (2019) Analysis of the depression and anxiety status and related risk factors in patients with lumbar disc herniation. Pak J Med Sci 35(3):658

    Google Scholar 

  24. Kossakowska K, Szczepanik M, Woszczak M (2018) Factors of subjective assessment of the effectiveness of physiotherapy: a study on patients with degenerative disease of the spine. Family Med & Primary Care Rev 20:131–138. https://doi.org/10.5114/fmpcr.2018.76455

    Article  Google Scholar 

  25. Chaichana KL, Mukherjee D, Adogwa O, Cheng JS, Mcgirt MJ, Chaichana KL (2011) Correlation of preoperative depression and somatic perception scales with postoperative disability and quality of life after lumbar discectomy. J Neurosurg Spine 14:261–267. https://doi.org/10.3171/2010.10.SPINE10190

    Article  PubMed  Google Scholar 

  26. Li S, Qi M, Yuan W, Chen H, Li S (2015) The impact of the depression and anxiety on prognosis of cervical total disc replacement. Spine 40:E266–E271. https://doi.org/10.1097/BRS.0000000000000743

    Article  PubMed  Google Scholar 

  27. Maratos EC, Trivedi R, Richards H, Seeley H, Laing RJC (2012) Psychological distress does not compromise outcome in spinal surgery. BRIT J NEUROSURG 26:466–471. https://doi.org/10.3109/02688697.2011.644821

    Article  Google Scholar 

  28. D’Angelo C, Mirijello A, Ferrulli A, Leggio L, Berardi A, Icolaro N, Miceli A, D’Angelo V, Gasbarrini G, Addolorato G (2010) Role of trait anxiety in persistent radicular pain after surgery for lumbar disc herniation. Neurosurgery 67:265–271. https://doi.org/10.1227/01.NEU.0000371971.51755.1C

    Article  PubMed  Google Scholar 

  29. Guan W, Zhao H, Han Y, Bai J (2004) Impact of depression on the curative effect of percutaneous lumbar discectomy for lumbar disc herniation. Chinese J Clini Rehabilit. https://doi.org/10.4055/cios.2017.9.2.177

    Article  Google Scholar 

  30. Jabłońska R, Ślusarz R, Królikowska A, Haor B, Antczak A, Szewczyk M (2017) Depression, social factors, and pain perception before and after surgery for lumbar and cervical degenerative vertebral disc disease. J Pain Res 10:89–99

    Article  Google Scholar 

  31. Taylor RE, Creed F, Hughes D (1997) Relation between psychiatric disorder and abnormal illness behaviour in patients undergoing operations for cervical discectomy. J Neurol Neurosurg Psychiatry 63:169–174. https://doi.org/10.1136/jnnp.63.2.169

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Urban-Baeza A, Zárate-Kalfópulos B, Romero-Vargas S, Obil-Chavarría C, Brenes-Rojas L, Reyes-Sánchez A, Urban-Baeza A (2015) Influence of depression symptoms on patient expectations and clinical outcomes in the surgical management of spinal stenosis. J Neurosurg Spine 22:75–79. https://doi.org/10.3171/2014.10.SPINE131106

    Article  PubMed  Google Scholar 

  33. Zong Y, Xue Y, Zhao Y, Ding H, He D, Li Z, Tang Y, Wang Y (2014) Depression contributed an unsatisfactory surgery outcome among the posterior decompression of the cervical spondylotic myelopathy patients: a prospective clinical study. Neurol Sci 35:1373–1379. https://doi.org/10.1007/s10072-014-1714-8

    Article  PubMed  Google Scholar 

  34. Levin JM, Rabah NM, Winkelman RD, Mroz TE, Steinmetz MP (2020) The impact of preoperative depression on hospital consumer assessment of healthcare providers and systems survey results in a cervical spine surgery setting. Spine 45:65. https://doi.org/10.1097/BRS.0000000000003222

    Article  PubMed  Google Scholar 

  35. Sinikallio S, Aalto T, Airaksinen O, Lehto SM, Kröger H, Viinamäki H, Sinikallio S (2011) Depression is associated with a poorer outcome of lumbar spinal stenosis surgery: a two-year prospective follow-up study. Spine 36:677–682. https://doi.org/10.1097/BRS.0b013e3181dcaf4a

    Article  PubMed  Google Scholar 

  36. Mu W, Shang Y, Zhang C, Tang S (2019) Analysis of the depression and anxiety status and related risk factors in patients with lumbar disc herniation. Pak J Med Sci 35:658–662

    Article  Google Scholar 

  37. Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS (2003) The epidemiology of major depressive disorder: results from the national comorbidity survey replication (NCS-R). J Am Med Assoc. https://doi.org/10.1001/jama.289.23.3095

    Article  Google Scholar 

  38. Pratt LA, Brody DJ (2014) Depression in the U.S. household population, 2009–2012. NCHS data brief:1

  39. Graaf R, Have M, Gool C, Dorsselaer S (2012) Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Soc Psych Psych Epid 47:203–213. https://doi.org/10.1007/s00127-010-0334-8

    Article  Google Scholar 

  40. Elsamadicy AA, Adogwa O, Cheng J, Bagley C (2016) Pretreatment of depression before cervical spine surgery improves patients’ perception of postoperative health status: a retrospective, single institutional experience. World Neurosurg 87:214–219. https://doi.org/10.1016/j.wneu.2015.11.067

    Article  PubMed  Google Scholar 

  41. Williams JW, Pignone M, Ramirez G, Perez Stellato C (2002) Identifying depression in primary care: a literature synthesis of case-finding instruments. Gen Hosp Psychiat 24:225–237. https://doi.org/10.1016/S0163-8343(02)00195-0

    Article  Google Scholar 

  42. Sinikallio S, Aalto T, Koivumaa-Honkanen H, Airaksinen O, Herno A, Kröger H, Viinamäki H (2009) Life dissatisfaction is associated with a poorer surgery outcome and depression among lumbar spinal stenosis patients: a 2-year prospective study. Eur Spine J 18:1187–1193. https://doi.org/10.1007/s00586-009-0955-3

    Article  PubMed  PubMed Central  Google Scholar 

  43. WHO (2017) Depression and other common mental disorders. WHO, Geneva

    Google Scholar 

  44. Walid MS, Zaytseva N (2011) The relationship of unemployment and depression with history of spine surgery. Perm J 15:19–22. https://doi.org/10.7812/tpp/10-086

    Article  PubMed  PubMed Central  Google Scholar 

  45. Boeschoten RE, Braamse AMJ, Beekman ATF, Cuijpers P, van Oppen P, Dekker J, Uitdehaag BMJ (2017) Prevalence of depression and anxiety in multiple sclerosis: a systematic review and meta-analysis. J Neurol Sci 372:331–341. https://doi.org/10.1016/j.jns.2016.11.067

    Article  PubMed  Google Scholar 

  46. Mata DA, Ramos MA, Bansal N, Khan R, Guille C, Di Angelantonio E, Sen S (2015) Prevalence of depression and depressive symptoms among resident physicians: a systematic review and meta-analysis. J Am Med Associ 314:2373–2383

    Article  CAS  Google Scholar 

  47. Perreault M, Touré EH, Perreault N, Caron J (2017) Employment status and mental health: mediating roles of social support and coping strategies. Psychiatr Q 88:501–514. https://doi.org/10.1007/s11126-016-9460-0

    Article  PubMed  Google Scholar 

  48. Bracke P, van de Straat V, Missinne S (2014) Education, mental health, and education-labor market misfit. J Health Soc Behav 55:442–459. https://doi.org/10.1177/0022146514557332

    Article  PubMed  Google Scholar 

  49. Cai B, Oderda GM (2012) The association between pain and depression and some determinants of depression for the general population of the United States. J Pain Palliat Care Pharmacother 26:257–265. https://doi.org/10.3109/15360288.2012.703292

    Article  PubMed  Google Scholar 

  50. John Wiley & Sons, Ltd, Chichester, UK (2006) Publication bias in meta‐analysis: prevention, assessment and adjustments

  51. Hunter JP, Saratzis A, Sutton AJ, Boucher RH, Sayers RD, Bown MJ (2014) In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias. J Clin Epidemiol 67:897–903. https://doi.org/10.1016/j.jclinepi.2014.03.003

    Article  PubMed  Google Scholar 

Download references

Funding

National Natural Science Foundation of China (Grant no. 31870961)

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Zhou Xiang.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (PPTX 298 KB)

Supplementary file2 (DOCX 60 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chen, Z., Luo, R., Yang, Y. et al. The prevalence of depression in degenerative spine disease patients: A systematic review and meta-analysis. Eur Spine J 30, 3417–3427 (2021). https://doi.org/10.1007/s00586-021-06977-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-021-06977-z

Keywords

Navigation