Introduction

Methods

Literature search

Review procedure

Discussion

Prevalence of LBP among young females

Females are at a greater risk of depression

What is the association between CLBP/chronic pain and depression in the youth?

Adolescents with pain are more likely to have depression

Activity levels and fear avoidance model

Predisposing and protective factors for comorbid depression in young with pain

Chronic pain and depression have common risk factors

Sleep disturbance, chronic pain and depression

Pattern of pain prescriptions among youth with chronic pain

Conclusions

Bibliography

Endnotes

Table of Figures

Figure 1 Review Process of the Literature

Figure 2 Source: AIHW analysis of ABS Microdata: National Health Survey, 2014–15

Figure 3 Prevalence of mental disorders across age groups

Figure 4 Original version of fear avoidance model

Figure 5 Modified Fear avoidance model predicting depression in paediatric population

Figure 6 Fear avoidance model predicting disability in paediatric population

Figure 7 Psychological factors impacting the Fear Avoidance Model

Tables

Table 1 Search Statement

Table 2 Studies demonstrating an association between pain and depression

Table 3 Studies examination activity levels and biomechanical factors

Table 4 Studies exploring the psychosocial variables associated with pain

Table 5 Studies examining the association of sleep disturbance with pain and depression

Introduction

Young Australian females have the greatest prevalence of psychological distress when compared across all age groups (1). Between 2011-12 and 2014-15, young females in the 18-24 age group were the only age group in Australia to have reported an increase in the prevalence of psychological distress (increasing from 13% to 20%) (1). What is concerning is whether this reduced mental wellbeing in young females will lead to a reciprocal rise in the incidence of low back pain (LBP[1]), as such pain often co-exists with depression leading to greater disability[2], reduced quality of life and increased healthcare visits among adolescents with chronic pain (2, 3). Furthermore, studies have demonstrated females are more likely to suffer from LBP than males (4, 5), and report greater stress levels from school that is associated with more health complaints, such as “musculoskeletal pain, fatigue, sleep disturbances, sadness and anxiety” (6). Adolescence and young adulthood is an opportunity for intervention to modify ?outcome as the onset of LBP frequently occurs in the 16-34 age group (7) as depicted in Figure 2 (prevalence 13.4% males, 14% females) (7). Since LBP that develops during adolescence is likely to persist into adulthood (8), along with the immense cost chronic LBP (CLBP) places on the Australian healthcare system ($1.2 billion per annum) (9), it is important to prevent or improve the management of LBP in this age group.

The majority of the research investigating the association between CLBP and depression is conducted in the older population (>40yrs). In contrast , research in the younger population explores chronic pain,[3] rather than CLBP specifically. Most of this research is conducted in countries outside of Australia as depicted in Table 2 – Table 5 (United States (10-13), Norway (14, 15), Sweden (16), Netherlands (17-19)), with only two studies conducted in young Australian adolescents and adults (3, 20). The existing chronic pain research involves children (8-12yrs) and younger adolescents (8-15yrs), and few young adults (18-25yrs). Therefore, to address this gap in the literature, this review aims to address the following primary research question: what is the association between CLBP and depression in young females aged 16-25yrs old?  The aims to address this question by exploring the topics outlined in the table of contents above.

Methods

Literature search

Three databases (PubMed, PsycINFO, Cinahl) were searched in February 2017 using the following Medical Subject Headings (MeSH) terms, titles and Boolean term as shown in Table 1.

Table 1 Search Statement