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Spinal pain and major depression in a military cohort: bias analysis of dependent misclassification in electronic medical records

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Abstract

Background

Spinal pain and major depression are prevalent conditions in adult populations and are particularly impactful in the military. However, the temporal relationship between these two conditions remains poorly understood.

Methods

Using data extracted from electronic medical records, we assessed the association between incident diagnoses of spinal pain and major depression in a cohort of 48,007 Canadian Armed Forces personnel followed from January 2017 to August 2018. We used multivariate Poisson regression to measure the association between the period prevalence of these two conditions. We used probabilistic bias modelling to correct our estimates for misclassification of spinal pain and major depression.

Results

After correcting for misclassification with probabilistic bias modelling, subjects newly diagnosed with spinal pain during the study period were 1.41 times (95% interval 1.25, 1.59) more likely also to be diagnosed with incident major depression, and personnel newly diagnosed with major depression were 1.28 times (95% interval 1.17, 1.39) more likely also to be diagnosed with spinal pain, compared to undiagnosed counterparts of the same age and sex. Without bias corrections, we would have overestimated the magnitude of the association between major depression and spinal pain by a factor of approximately 2.0.

Conclusion

Our results highlight a moderate and bi-directional association between two of the most prevalent disorders in military populations. Our results also highlight the importance of correcting for misclassification in electronic medical record data research.

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Funding

This work was supported by funding from the Canada Research Chairs program to I.C. and funding from the Surgeon General Health Research Program to FLT. The Research Council of Norway partly supported this work through its Centres of Excellence funding scheme, project number 262700.

Author information

Authors and Affiliations

  1. Canadian Forces Health Services Group, Department of National Defence, Ottawa, Canada

    François L. Thériault, Robert A. Hawes & Bryan G. Garber

  2. School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada

    François L. Thériault, Franco Momoli, Bryan G. Garber, William Gardner & Ian Colman

  3. Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada

    William Gardner

Authors
  1. François L. Thériault
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  2. Franco Momoli
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  6. Ian Colman
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Contributions

All authors contributed to the study’s conception and design. RAH and FLT performed data collection. Data analysis was performed by FLT. The first draft of the manuscript was written by FLT, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to François L. Thériault.

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Conflicts of interest

None declared.

Ethical approval

This study was approved by the CAF Deputy Surgeon General and the University of Ottawa Office of Research Ethics and Integrity.

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Thériault, F.L., Momoli, F., Hawes, R.A. et al. Spinal pain and major depression in a military cohort: bias analysis of dependent misclassification in electronic medical records. Soc Psychiatry Psychiatr Epidemiol 57, 575–581 (2022). https://doi.org/10.1007/s00127-021-02160-3

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