Prospective relationship between neck pain and depressive symptoms, and the moderating effect of physical exercise

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Background and aims Chronic neck pain (CNP) is common, and causes significant individual and societal burden. CNP can be associated with depression and as co-morbidities yield worse clinical outcomes. Evidence supports exercise as a conservative intervention for CNP and depression independently but little is known about the impact of exercise on the CNP-depression relationship. Methods The 1958 British Cohort provided self-reported data on CNP at age 45, and depressive symptoms at ages 45 (Clinical Interview Schedule–Revised) and 50 (Short Form–36). Cross-sectional and prospective relationships were analysed by fitting logistic regression models adjusted only for sex, and fully adjusted for multiple covariates. All models incorporated CNP, weekly exercise (yes/no) and an interaction term. Area under the receiver operating characteristic curve was calculated for all models, and sensitivity analysis with multiple imputation for missing data was completed for full models. Results CNP was associated with depressive symptoms cross-sectionally (full model OR = 1.67; 95% CI 1.19, 2.35, N = 7493; p = 0.003) and prospectively (full model OR = 1.54; 95% CI 1.11, 2.16; N = 6341; p = 0.011). No moderating effect of exercise was observed. Both full models had a binary classification accuracy of approximately 70%, even when CNP or the exercise x CNP interaction were removed as predictors. Conclusion Individuals with CNP are at higher risk of concurrent and future depressive symptoms. Though exercise is a promising clinical intervention for depression amongst persons with CNP, we did not find it to have a moderating effect. Further research in larger cohorts is recommended.

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