The mediating role of depressive symptoms among Turkish population related to gender and low back pain: evidence from a national health survey

Abstract

Background: Low back pain (LBP), though non-life-threatening, burdens healthcare with treatment expenses and work hours lost. Globally, 70–84% experience it, with risk factors tied to societal structure, income, and living conditions, making it a leading cause of disability. Methods: This study utilized data from the 2019 Türkiye Health Survey, which consisted of 17,084 individuals aged 15 and above. Our study focused on investigating the factors related to low back pain through a cross-sectional analysis. To analyze these factors, we employed binary multivariate logistic regression. Additionally, we conducted post-hoc analyses to assess the potential mediating effect of depressive symptoms on the relationship between low back pain and gender. Results: We found that 31.9% of the population experienced low back pain, with women being 58% more likely [aOR = 1.58; 95% CI (1.45–1.73)] than men to report symptoms. Individuals aged 55 + years old had a 90% [aOR = 1.90; 95% CI (1.61–2.23)] chance of experiencing low back pain, indicating an age-related increase. In the general population, having depressive symptoms was 2.49 [95% CI (2.23–2.78)] times more likely associated with low back pain. Our mediation analysis showed that gender (i.e., women vs. men), indicated by direct effects with ?-estimates e = 0.78, predicted the likelihood of low back pain. Additionally, the relationship between gender and low back pain, mediated through a history of depressive symptoms, had a significant total indirect effect (i.e., ?-estimate given as e = 0.49). Specifically, a history of depressive symptoms accounted for 17.86% [95% CI (9.67–20.10)] of the association between women having a higher likelihood of low back pain compared to men. Conclusion: We observed that a higher likelihood of low back pain associated with gender and aging. Additionally, BMI served as a significant predictor, particularly in adults. Depression mediated the association between gender and low back pain. Acknowledging these associations may help identify and address contributing factors to LBP, potentially increasing awareness and alleviating the burden. Policymakers and healthcare professionals may consider these findings when developing prevention and treatment programs for low back pain.