Association of depressive symptoms with risk of incidence low back pain in middle-aged and older Chinese adults

Elevated Depressive symptoms (DS) and low back pain (LBP) pose significant and growing public health challenges, and China is no exception. This study innovatively examined the relationship between specific DS and distinct patterns of DS and incident LBP. This study extracted data from 4713 participants aged 45+ years from the China and Health Retirement Longitudinal Study (CHARLS), followed-up for incidence LBP (June 2011–September 2020). DS was assessed by the 10-item Center for Epidemiological Studies Depression Scale (CESD-10). The incident LBP was determined by self-reported. Latent class analysis (LCA) was employed to categorize patterns of DS. Cox proportional hazards regression models were used to examine the association between DS and incident LBP. Over the 9.25-year follow-up period, 2234 incident LBP cases were identified. There was a significant independent association between positive DS and incident LBP with an HR of 1.73 (95 % CI = 1.55–1.94). Of the 10-item DS, difficulty concentrating (adjusted HR = 1.16, 95 % CI = 1.03–1.31), effortfulness (adjusted HR = 1.32, 95 % CI = 1.18–1.49), hopelessness (adjusted HR = 1.13, 95 % CI = 1.02–1.25), restless sleep (adjusted HR = 1.17, 95 % CI = 1.06–1.30), and loneliness (adjusted HR = 1.18, 95 % CI = 1.02–1.36), each independently associated with incident LBP. Regarding patterns of DS, compared to the "healthy" pattern of DS, four patterns showed significant association with incident LBP, especially the cumulative pattern of DS. DS and LBP were assessed based on self-reported. In middle-aged and older Chinese adults, 5 specific DS (difficulty concentrating, effortfulness, hopelessness, restless sleep, and loneliness) and distinct patterns of DS indicate varied risks of developing LBP.