Sanna Sinikallio

Depression is associated with a poorer outcome of lumbar spinal stenosis surgery: a two-year prospective follow-up study.

Study Design. Prospective clinical study. Objective. To investigate the effect of depressive symptoms on the surgery outcome on 2-year follow-up among lumbar spinal stenosis (LSS) patients. Summary of Background Data. Previous research has suggested an association between preoperative depressive symptoms and a poorer surgery outcome among LSS patients. There have been no previous studies on the effect of depressive symptoms on the surgery outcome at the 2-year postoperative phase. Methods. A total of 96 patients (mean age, 62 years) with symptomatic LSS underwent decompressive surgery. They completed the same set of questionnaires before surgery and 3 months, 6 months, 1 year, and 2 years after surgery. Depression was assessed with the 21-item Beck Depression Inventory (BDI). Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability, he visual analogue scale, and pain drawing. Comparisons were made according to depression status. Logistic regression analysis was used to examine the factors associated with a poorer surgery outcome on 2-year follow-up. Results. After surgery, the patients with continuous depression showed poorer improvement in symptom severity, the disability score, and walking capacity than the patients who did not have depression in any phase. In those patients who recovered from depression, the postoperative improvement resembled that of the constant normal mood group. In regression analyses, an independent association was detected between high preoperative BDI scores and 2-year disability and symptom severity. Strong independent associations were seen between depression burden (the sum of preoperative, 3-month and 6-month BDI scores) and 2-year disability, symptom severity, and poor walking capacity. Conclusion. The patients with a normal mood and those who recovered from depressive symptoms enjoyed the most favorable outcome. Depressive symptoms interfere strongly with the ability of patients to obtain an optimal surgery outcome. Treatment models including the assessment and treatment of depression are encouraged.

Depressive Burden in the Preoperative and Early Recovery Phase Predicts Poorer Surgery Outcome Among Lumbar Spinal Stenosis Patients: A One-year Prospective Follow-up Study

Study Design. Prospective clinical study. Objective. (1) To determine the prevalence of depression at the 1-year postoperative stage among spinal stenosis patients. (2) To assess the predictive value of preoperative and 3-month depressive symptoms regarding the 1-year surgery outcome. Summary of Background Data. Some studies have found preoperative depressive symptoms to be associated with a poorer spinal stenosis surgery outcome. However, only the effect of preoperative depressiveness has been evaluated. The prevalence of depressiveness on 1-year follow-up among spinal stenosis patients is unclear. Methods. One hundred two patients (mean age, 62 years) with symptomatic lumbar spinal stenosis underwent decompressive surgery. They completed the same set of questionnaires before surgery, 3 months, and 1 year after surgery. Depression was assessed with the 21-item Beck Depression Inventory. Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability, the visual analogue scale and pain drawing. Logistic regression was used to examine the preoperative factors associated with a poorer surgery outcome on 1-year follow-up. In further analysis, a depressive burden variable (sum of preoperative and 3-month Beck Depression Inventory scores) was included as a predictor. Results. Eighteen percent of spinal stenosis patients were depressed on 1-year follow-up. Higher preoperative Beck Depression Inventory scores and depressive burden scores burden were independently associated with a poorer self-reported functional ability, symptom severity and a poorer walking capacity on 1-year follow-up. As a dichotomous predictor, a high depressive burden was independently associated with all the postoperative outcome variables at the 1-year stage: greater disability, pain and symptom severity, and a poorer walking capacity. Conclusion. The prevalence of depression was notable among 1-year postoperative spinal stenosis patients. Depressive symptoms in the preoperative and early recovery phase were strong predictors of a poorer self-reported surgery outcome on 1-year follow-up. The results call for intervention strategies to detect and treat depression during both the preoperative and postoperative phase.

Depression and associated factors in patients with lumbar spinal stenosis

Purpose. To investigate the prevalence of depression and associated factors in patients (n = 100) with lumbar spinal stenosis selected for surgical treatment. Method. Depression was assessed with the 21-item Beck Depression Inventory. Psychological well-being was assessed with Life Satisfaction Scale, Toronto Alexithymia Scale and Sense of Coherence Scale. Physical functioning and pain were assessed with the Oswestry disability index, the questionnaire devised by Stucki and the Visual Analogue Scale. All questionnaires were administered before surgical treatment of lumbar spinal stenosis. Results. Twenty percent of the patients with LSS were found to have clinically important depression. In univariate analyses, subjective disability measured with the Oswestry disability index, low sense of coherence and poor life satisfaction were common in depressed patients. In the multiple logistic regression analyses, being dissatisfied with life was associated with depression. When sense of coherence score was included in the model, then only low sense of coherence was independently associated with depression. Neither socio-demographic nor pain-related factors associated with depression. Conclusions. Clinically important depression is rather common among preoperative patients with lumbar spinal stenosis. The factors associated with depression are subjective disability of everyday living and decreased life satisfaction. A low sense of coherence is an important correlate of depression. The results underline the importance of assessing depression in clinical practice dealing with these patients.

Depressive burden is associated with a poorer surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study

BACKGROUND CONTEXT In lumbar spinal stenosis (LSS), conservative treatment is usually the first choice of treatment. If conservative treatment fails, surgery is indicated. Psychological factors such as depression and anxiety are known to affect the outcome of surgery. Previous studies on depression and surgery outcome using long follow-up times are scarce. PURPOSE The purpose of this study was to investigate the effect of depressive symptoms on the surgical outcome during a 5-year follow-up among patients with LSS. STUDY DESIGN A prospective observational study. PATIENT SAMPLE Patient sample included 102 LSS patients who needed surgical treatment. OUTCOME MEASURES The outcome of surgery was evaluated with the Oswestry Disability Index (ODI), visual analog scale pain assessment, and self-reported walking capacity. METHODS The patients completed a set of questionnaires preoperatively and 3 and 6 months, as well as 1, 2, and 5 years after the surgery. Depressive symptoms were assessed with the Beck Depression Inventory. The depressive burden was estimated by summing all individual Beck Depression Inventory scores. Statistical analyses included cross-sectional group comparisons and linear regression analyses. No conflicts of interest. RESULTS On 5-year follow-up, a high depressive burden associated with a poorer outcome of surgery when assessed with the ODI. In linear regression analysis, a high depressive burden associated with higher ODI score. CONCLUSIONS Even slightly elevated long-term depressive symptoms in LSS patients are associated with an increased risk of a poorer functional ability after decompressive surgery.

Determinants of pain and functioning in knee osteoarthritis: a one-year prospective study

Objective: To identify predictors of pain and disability in knee osteoarthritis. Design: A one-year prospective analysis of determinants of pain and functioning in knee osteoarthritis. Study setting: Primary care providers in a medium-sized city. Patients: A total of 111 patients aged from 35 to 75 with clinical symptoms and radiographic grading (Kellgren-Lawrence 2–4) of knee osteoarthritis who participated in a randomized controlled trial. Main measures: The outcome measures were self-reported pain and function, which were recorded at 0, 3 and 12 months. Disease-specific pain and functioning were assessed using the pain and function subscales of the Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index. Generic physical and mental functioning were assessed using the RAND-36 subscales for function, and physical and mental component summary scores. Possible baseline predictors for these outcomes were 1) demographic, socioeconomic and disease-related variables, and 2) psychological measures of resources, distress, fear of movement and catastrophizing. Results: Multivariate linear mixed model analyses revealed that normal mood at baseline measured with the Beck Anxiety Inventory predicted significantly better results in all measures of pain (WOMAC P=0.02) and function (WOMAC P=0.002, RAND-36 P=0.002) during the one-year follow-up. Psychological resource factors (pain self-efficacy P=0.012, satisfaction with life P=0.002) predicted better function (RAND-36). Pain catastrophizing predicted higher WOMAC pain levels (P=0.013), whereas fear of movement (kinesiophobia) predicted poorer functioning (WOMAC P=0.046, RAND-36 P=0.024). Conclusions: Multiple psychological factors in people with knee osteoarthritis pain are associated with the development of disability and longer term worse pain.

Somatic comorbidity and younger age are associated with life dissatisfaction among patients with lumbar spinal stenosis before surgical treatment

The objective of the study was to examine self-reported life satisfaction and associated factors in patients (n=100) with lumbar spinal stenosis (LSS) in secondary care level, selected for surgical treatment. Life satisfaction was assessed with the four-item Life Satisfaction scale. Depression was assessed with a 21-item Beck Depression Inventory (BDI). Psychological well-being was assessed with Toronto Alexithymia Scale and Sense of Coherence Scale. LSS related physical functioning and pain were assessed with Oswestry disability index, Stucki questionnaire, Visual Analogue Scale and pain drawings. All questionnaires were administered before surgical treatment of LSS. Results showed that 25% of the patients with LSS were found to be dissatisfied with life. In a univariate analysis, smoking, elevated subjective disability scores and extensive markings in the pain drawings were more common in the dissatisfied patients. The dissatisfied patients also showed lower coping resources, elevated alexithymia and depression scores, and were more often depressed. In multiple logistic regression analyses, only younger age and somatic comorbidity were associated with life dissatisfaction. This association remained significant even when the BDI score was added into the model. No other significant associations emerged. In conclusion, life dissatisfaction was rather common among preoperative LSS patients. Pain and constraints on everyday functioning were important correlates of life dissatisfaction. However, only younger age and somatic comorbidity were independently associated with life dissatisfaction. These results emphasize the importance of recognizing and assessing the effect of coexisting medical conditions and they need to be addressed in any treatment program.

Unemployment and ill health: a connection through inflammation?

BackgroundUnemployment is a source of acute and long-term psychosocial stress. Acute and chronic psychosocial stress can induce pronounced changes in human immune responses. In this study we tested our hypothesis that stress-induced low-grade tissue inflammation is more prevalent among the unemployed.MethodsWe determined the inflammatory status of 225 general population subjects below the general retirement age (65 years in Finland). Those who had levels of both interleukin-6 (≥ 0.97 pg/mL) and high-sensitivity C-reactive protein (≥ 1.49 mg/L) above the median were assessed to have an elevated inflammatory status (n = 72).ResultsAn elevated inflammatory status was more common among the unemployed than among other study participants (59% versus 30%, p = 0.011). In the final multivariate model, those who were unemployed had over five-fold greater odds for having an elevated inflammatory status (OR 5.20, 95% CI 1.55-17.43, p = 0.008).ConclusionThis preliminary finding suggests that stress-induced low-grade inflammation might be a link between unemployment and ill health.

Serum adipokine levels in adults with a history of childhood maltreatment.

Individuals with a history of childhood maltreatment present increased rates of metabolic disturbances, but the underlying mechanisms for such phenomena are poorly understood. This study examined whether the secretion of adipokines, adipocyte-derived inflammation markers closely associated with metabolic disorders, is altered in individuals with a history of childhood maltreatment. The serum levels of inflammatory markers adiponectin and resistin were measured from 147 general population participants who had a history of adverse mental symptoms, and who also reported their experiences of childhood maltreatment. Participants with experiences of childhood maltreatment (n=30) had lowered levels of serum adiponectin (p=0.007) and resistin (p=0.028). The differences in adiponectin levels persisted in multivariate modeling with adjustments for age, gender, and body mass index (OR for each 1 standard deviation decrease in the serum adiponectin level 2.65, 95% CI 1.31-5.35, p=0.007). Additional adjustments for marital status or a diagnosis of major depressive disorder, or the exclusion of individuals using NSAIDs, oral corticosteroids, or antidepressants did not alter the results. The association between resistin levels and childhood maltreatment did not remain independent in the same models. Our findings suggest that in individuals with previously reported adverse mental symptoms, a history of childhood maltreatment is independently associated with lowered levels of the anti-inflammatory marker adiponectin. This may lead to a lowered anti-inflammatory buffer capacity, which can, in turn, increase the susceptibility to physical and psychological states characterized by pronounced pro-inflammation.

Effectiveness of a cognitive-behavioral group intervention for knee osteoarthritis pain: protocol of a randomized controlled trial

BackgroundKnee osteoarthritis is the most common type of arthritis, with pain being its most common symptom. Little is known about the psychological aspects of knee osteoarthritis pain. There is an emerging consensus among osteoarthritis specialists about the importance of addressing not only biological but also psychosocial factors in the assessment and treatment of osteoarthritis. As few studies have evaluated the effect of psychological interventions on knee osteoarthritis pain, good quality randomized controlled trials are needed to determine their effectiveness.Methods/DesignWe intend to conduct a 6-week single-blinded randomized controlled trial with a 12-month follow-up. Altogether, 108 patients aged from 35 to 75 years with clinical symptoms and radiographic grading (KL 2–4) of knee osteoarthritis will be included. The clinical inclusion criteria are pain within the last year in or around the knee occurring on most days for at least one month, and knee pain of ≥40 mm on a 100-mm visual analogue scale in the WOMAC pain subscale for one week prior to study entry. Patients with any severe psychiatric disorder, other back or lower limb pain symptoms more aggravating than knee pain, or previous or planned lower extremity joint surgery will be excluded. The patients will be randomly assigned to a combined GP care and cognitive-behavioral intervention group (n = 54) or to a GP care control group (n = 54). The cognitive-behavioral intervention will consist of 6 weekly group sessions supervised by a psychologist and a physiotherapist experienced in the treatment of pain. The main goals of the intervention are to reduce maladaptive pain coping and to increase the self-management of pain and disability. The follow-up-points will be arranged at 3 and 12 months. The primary outcome measure will be the WOMAC pain subscale. Secondary outcome measures will include self-reports of pain and physical function, a health related quality of life questionnaire, and various psychological questionnaires. Personnel responsible of the data analysis will be blinded.DiscussionThis study addresses the current topic of non-pharmacological conservative treatment of knee OA-related pain. We anticipate that these results will provide important new insights to the current care recommendations.Trial registrationCurrent Controlled Trials ISRCTN64794760

Depressive symptoms predict postoperative disability among patients with lumbar spinal stenosis: A two-year prospective study comparing two age groups

Purpose. To examine the importance of preoperative and recovery phase depressive symptoms in two age groups of patients with lumbar spinal stenosis (LSS) with respect to surgery outcome 2 years postoperatively. Method. Ninety-six patients with symptomatic LSS underwent decompressive surgery. Data were collected with self-report questionnaires before surgery and 3 months, 6 months, 1 year and 2 years postoperatively. Depression was assessed with the Beck Depression Inventory (BDI). Depressive burden was examined by compiling the sum of preoperative, 3-month and 6-month BDI scores. Physical functioning and pain were assessed with the Oswestry Disability Index, Walking ability and VAS. In the analyses, the subjects were divided into two groups according to the median age (62 years). Results. Depressive burden was a strong predictor of disability at the 2-year postoperative phase both in younger and elderly patients with LSS. A notable proportion (20%) of the younger patients had considerable depressive symptomatology 2 years after the surgery, whereas in the older age group this proportion was 8%. Conclusion. The results suggest that there is a strong relationship between depressive symptoms and disability among postoperative patients with LSS. Identifying and treating patients with preoperative and postoperative depressive symptoms may be a useful strategy for improving LSS surgery outcomes.