Depression predicts decreased lumbar bone mineral density: A scoping review of chronic psychological stress and spinal tissue pathology.

Objective: Chronic low back pain (cLBP) is a complex disease with biological, psychological, and social components and the complex interactions of these components are poorly understood. Chronic psychological stress (CPS) (anxiety, depression, etc.) and pathological changes in spinal tissue (osteoporosis, disc degeneration, etc.) are frequently and independently associated with cLBP, yet their explicit relationship has not been collectively reviewed. The objective of this scoping review is to investigate the current state of research on how CPS may impact spinal tissue pathology. Design: Five steps were utilized to conduct this scoping review: 1) identify a research objective and establish a search strategy, 2) identify research articles, 3) select research articles that meet search criteria, 4) extract data, 5) summarize and report results. Results: We identified N ​= ​56 articles relating CPS to spinal pathology. Of those that identified a relationship between CPS and spine pathology (N ​= ​39), most (N ​= ​24) described decreased lumbar vertebral bone mineral density (BMD) between depression and control groups. Animal studies (N ​= ​8) were limited to mice and confirmed a causal relationship between CPS and lower vertebral BMD. Only a few additional human studies (N ​= ​9) documented relationships between other various forms of CPS and spinal tissue pathologies. Conclusion: This scoping review documents evidence of a relationship between CPS and decreased spine health in humans as well as a causal relationship between the initiation of CPS and decreased BMD in animals. As few studies evaluated disease in other spinal anatomy in relationship to CPS, future work in this area is warranted. Further exploration of CPS beyond depression is warranted as well.