ARTÍCULO ORIGINAL
REVISTA DE LA FACULTAD DE MEDICINA HUMANA 2021 - Universidad Ricardo PalmaDOI 10.25176/RFMH.v21i1.3229
LUMBAR PAIN RELATED TO ANXIETY AND DEPRESSION IN POLICE OFFICERS OF A POLICE STATION IN LIMA.
DOLOR LUMBAR RELACIONADO CON ANSIEDAD Y DEPRESIÓN EN POLICÍAS DE UNA COMISARÍA EN LIMA.
Arleen Yesenia Espinoza Ventura1,a, Cristhian Santiago Bazan2,b,c
1 Universidad Arzobispo Loayza, Lima, Perú.
2 UCentro de Rehabilitación Integral Física Funcional, Lima, Perú.
a Bachelor in Medical Technology.
b Medical Technologist Graduated in Physical Therapy and Rehabilitation.
c Phd in Education.
ABSTRACT
Introduction: Lumbar pain is a public health problem which carries some kind of functional limitation in the individual affecting the quality of life of police personnel. Objective: Linking lower back pain to anxiety and depression in police officers at a police station in Lima. Methods: It is research with a quantitative, descriptive, transversal analytical and correlal approach, there was the participation of 110 participants, which was obtained through a probabilistic show where all participants had the same opportunity to participate, was conducted at the Monserrat Commissioner, a questionnaire survey was used to measure lower back pain in police personnel "CDLPP" whose reliability was 0.914 alpha crombach and to measure anxiety and depression Zung's test. Results: 75.5% of police officers with lower back pain were shown. A statistically significant relationship between anxiety and lower back pain (p-0.028) was also evident. Similarly, there was no statistically significant association between lower back pain and depression (P > 0.05). Conclusion: Lumbar pain is associated with anxiety in police officers, a police station in Lima. Also a high percentage of police officers suffering from lower back pain, considering that it is a public health problem, which could lead to future some type of disability affecting their quality of life.
Keywords: Low back pain, anxiety, depression, police. (Source: MESH – NLM)
Introduction: Lumbar pain is a public health problem which carries some kind of functional limitation in the individual affecting the quality of life of police personnel. Objective: Linking lower back pain to anxiety and depression in police officers at a police station in Lima. Methods: It is research with a quantitative, descriptive, transversal analytical and correlal approach, there was the participation of 110 participants, which was obtained through a probabilistic show where all participants had the same opportunity to participate, was conducted at the Monserrat Commissioner, a questionnaire survey was used to measure lower back pain in police personnel "CDLPP" whose reliability was 0.914 alpha crombach and to measure anxiety and depression Zung's test. Results: 75.5% of police officers with lower back pain were shown. A statistically significant relationship between anxiety and lower back pain (p-0.028) was also evident. Similarly, there was no statistically significant association between lower back pain and depression (P > 0.05). Conclusion: Lumbar pain is associated with anxiety in police officers, a police station in Lima. Also a high percentage of police officers suffering from lower back pain, considering that it is a public health problem, which could lead to future some type of disability affecting their quality of life.
Keywords: Low back pain, anxiety, depression, police. (Source: MESH – NLM)
INTRODUCTION
Lumbar pain is a musculoskeletal injury considered a public health problem, causing a social and economic impact on the population. There are different ergonomic, postural, emotional factors, etc., which could lead to a functional limitation affecting the individual's quality of life. Likewise, if the person has chronic lumbar pain, they have a higher risk of suffering a higher level of disability1,2.
Lumbar pain is usually nonspecific or mechanical when intrinsically from the spinal column (the intervertebral discs or surrounding soft tissues). On the other hand, non-mechanical lumbar pain includes a progressive motor or sensory loss, new urinary retention or overflow incontinence, history of cancer, recent invasive spinal procedure, and significant age-related trauma3.
People of active working age are subject to a series of physical factors, typical of daily life activities4. For many years, lumbar pain has been the leading cause of absence from work as the ultimate indication for medical rehabilitation due to disability5,6.
On the other hand, common psychological problems are significantly associated with musculoskeletal disorder patterns7. Likewise, the comorbidity of anxiety and depression is related to pain intensity, pain-related disability, and health-related quality of life8.
In addition, epidemiological studies found some psychiatric disorders found more commonly among people with chronic pain, such as headache, back pain, than those without chronic pain. Some psychiatric disorders, such as depression, increase the risk of chronic pain and its persistence. These clinical studies suggest that chronic pain is not common comorbidity among people with other psychiatric disorders, such as dementia and schizophrenia. It is not clear if this is a consequence of some specific biological mechanism or methodology problems in the studies9.
The functions of the National Police of Peru are an organism of the Peruvian state in charge of guaranteeing, maintaining, and reestablishing internal order, providing protection and assistance to people and the community, and ensuring compliance with the security laws of the public and private assets10.
Most of these police officers have a level of psychosocial exposure unfavorable to their health in terms of insecurity, occupational stressors, such as organization (for example, staff shortages, inconsistent leadership styles), and operational elements (for example, work by turns, public scrutiny). A working schedule is 3-5 times a week, and they cannot choose their time off. Regarding physical exposure, their work demands to be standing during the entire shift of their work. This is a negative factor in terms of the posture of which it has generated some kidney problems, varicose veins, and the most common is swelling of feet. Most of the officers are unaware of active breaks; therefore, they do not take them11,12. The present objective is to determine the association of lumbar pain with anxiety and depression in police officers from a Lima police station.
METHODS
Design and study area
A descriptive, cross-sectional, analytical, and correlation study was carried out.
Population and sample
The study population was made up of the police from the Monserrat Police Station, located in Lima, Peru, during January and February 2020. All police officers who freely agreed to participate in the study were included, with prior informed consent. Exclusions included cops that were discharged, removed, and those who have had some back surgery or degenerative pathologies of any type of infectious disease, participants who are receiving physical therapy or pain relief drugs. The required sample was 110 participants, which was obtained through probability sampling.
Variables and instruments
For the measurement of lumbar pain, the instrument called a questionnaire to measure lumbar pain in police personnel ¨CDLPP¨, which consists of 12 questions, was taken into consideration presence of lumbar pain (yes/no) , chronicity of pain (acute, chronic), intensity of lumbar pain (none, mild, moderate, severe, frequency of lumbar pain (never, almost never, sometimes, almost always, always), Type of sensation of lumbar pain (numbness , burning, squeezing, stabbing, other pain), persistence of lumbar pain (less than 15 minutes, 16 to 30 minutes, 31 to 60 minutes, 1 to 2 hours), side of the lumbar region (right, left, both sides, in the center), activities increased lumbar pain (bending over, carrying light objects, being able to turn your body, carrying heavy items), limitation in the work environment (never, almost never, sometimes, almost always, always), relief of lumbar pain (rest, take medicine prescribed by the doctor, take medication without a prescription, take natural remedies, go to the specialist professional, information on lumbar pain (yes/no). This instrument validation went through expert judgment from four experts and had judges reliability of 0,914 evaluated according to Cronbach's alpha.
On the other hand, to measure anxiety, the Zung test was used, classifying anxiety as: no anxiety (normal), minimal to moderate, marked to severe and maximum grade13; ; while for the depression variable, the Zung Self-Rating Depression Scale was used, classifying depression as no depression (normal), slightly depressed, moderately depressed, severely depressed14.
Procedures
For data collection, permission was requested from the Monserrat police station commissioner; once granted, the information collection began during January and February 2020.
Statistical analysis
For the analysis, Statistical program SPSS v. 24 was used. Regarding the statistical analysis, the univariate and bivariate analysis were taken into consideration. Regarding the univariate analysis, the categorical variables (frequency and percentage) and the numerical variables (mean and standard deviation) were considered.
On the other hand, statistical parameters were taken into consideration to measure the association between categorical variables; the Chi-Square test was performed to measure the relationship between lumbar pain with anxiety and depression, significant differences were considered if the p-value it was less than 0.05.
Ethical considerations
Bioethical criteria were taken into account in scientific research (autonomy, justice, beneficence, and non-maleficence). The patients' informed consent and the institution’s permission were used to carry out the research. Likewise, respect for privacy and free participation of those investigated prior to the collection of information was guaranteed.
RESULTS
Of the total of 110 participants, 93.6% were men and 6.4% women. 50.9% of the participants declared to be married, 46.4% were single, 1.8% were divorced, and 0.9% were widowed. The average age of the participants was 38.3, with an age range of 21 to 60 years. The sociodemographic characteristics of the study sample were shown in Table 1.
Regarding the participants’ lumbar pain, it was obtained that 75.5% had lumbar pain while 15.5 % did not present lumbar pain. Regarding the anxiety of the participants, it was obtained that 84.5% presented a normal degree of anxiety, 13.6% showed a degree of anxiety from minimal to moderate, and 1.8% presented a degree of anxiety from marked to severe. Regarding the depression of the participants, it was obtained that 80% did not present depression, while 20% presented mild to moderate depression. Table 2 shows the results obtained from the measurement instruments applied to the population that participated in the study.
When performing the bivariate analysis on the relationship between anxiety and depression with lumbar pain, it was found that 63.6% of those surveyed with lumbar pain had a normal degree of anxiety, while 11.8% of those surveyed with lumbar pain. Lumbar pain presented a degree of minimal to moderate anxiety (p = 0.028). In addition, 60.9% of those surveyed with lumbar pain did not present depression, while 14.5% of those surveyed with lumbar pain presented mild to moderate depression (p = 0.740). The other data for analysis are found in Table 2.
Regarding the clinical characteristics of the participants’ lumbar pain, it was found that 46.4% were chronic, 34.5 % was of moderate-intensity, 50% sometimes presented pain, 17.3% pain was puncture type and 30% presented pain on both sides. Table 3 details the results obtained from the measurement instrument applied to the population that participated in the study.
DISCUSSION
Musculoskeletal disorders are considered a major problem affecting the health and well-being of active-duty police. Discomfort from wearing mandatory equipment and sitting for long periods in fleet vehicles are workload factors related to musculoskeletal disorders in the police13.
Regarding lumbar pain, 75.5% of police officers present lumbar pain. This agrees with several previous reports Cardoso E14, Brown JJ15, Gruevski KM16. This problem is severe and frequent in police personnel17. While it is true, the police’s activity is exposed to a series of factors that could affect their health and produce physical disability. Some carry out internal functions such as administrative activities, others patrol, standing for many hours, and carrying heavy equipment. Adding the working conditions, can lead to an overload of the column18.
Regarding anxiety and its relationship with lumbar pain (p = 0.028), studies such as Douma NB19. This agrees with several previous reports Santiago C20, Barreda E21. Likewise, anxiety and depression disorders are increasingly affecting society. Anxiety disorders are the most common psychiatric disorders, and depressive disorders are increasing in society globally. Lumbar pain is one of the common health problems experienced by 50-80% of adults at some point in their lives22.
Regarding depression, a study by Jara JA23. People with symptoms of depression are at higher risk of developing an episode of lumbar pain in the future, with the risk being higher in patients with more severe levels of depression24. Anxious manifestations accompany this high proportion of depressive disorders, and these frequently present with pain. Likewise, these painful manifestations cause or worsen depressive and anxious symptoms25.
On the other hand, the individual’s psychological aspects are important in the development and progression of lumbar pain. It is important to consider that the official personnel, in the presence of pain, rest, and take medications prescribed by the specialist, similar to a study mentioned by Anderson G26. Likewise, back pain is a factor to increase the probability of depression27.
This type of Investigation in police personnel is of utmost importance, because of the characteristics demanded by their work in the development of their functions. They are exposed to physical and functional injury, and in their emotional state, problems could hinder missions. Early detection could avoid any kind of subsequent consequences.
Despite the present research, which was supported by the participants. It had limitations, including the little and scarce national background information about lumbar pain publications in police personnel. Likewise, he may have had a recall or memory bias when completing the questionnaire alternatives, to recall experiences accurately.
CONCLUSION
Lumbar pain is associated with anxiety in police officers at a police station in Lima. Likewise, a high percentage of police officers who suffer from lumbar pain consider it a public health problem, which could lead to some type of disability in the future, affecting their quality of life.
Lumbar pain is a musculoskeletal injury considered a public health problem, causing a social and economic impact on the population. There are different ergonomic, postural, emotional factors, etc., which could lead to a functional limitation affecting the individual's quality of life. Likewise, if the person has chronic lumbar pain, they have a higher risk of suffering a higher level of disability1,2.
Lumbar pain is usually nonspecific or mechanical when intrinsically from the spinal column (the intervertebral discs or surrounding soft tissues). On the other hand, non-mechanical lumbar pain includes a progressive motor or sensory loss, new urinary retention or overflow incontinence, history of cancer, recent invasive spinal procedure, and significant age-related trauma3.
People of active working age are subject to a series of physical factors, typical of daily life activities4. For many years, lumbar pain has been the leading cause of absence from work as the ultimate indication for medical rehabilitation due to disability5,6.
On the other hand, common psychological problems are significantly associated with musculoskeletal disorder patterns7. Likewise, the comorbidity of anxiety and depression is related to pain intensity, pain-related disability, and health-related quality of life8.
In addition, epidemiological studies found some psychiatric disorders found more commonly among people with chronic pain, such as headache, back pain, than those without chronic pain. Some psychiatric disorders, such as depression, increase the risk of chronic pain and its persistence. These clinical studies suggest that chronic pain is not common comorbidity among people with other psychiatric disorders, such as dementia and schizophrenia. It is not clear if this is a consequence of some specific biological mechanism or methodology problems in the studies9.
The functions of the National Police of Peru are an organism of the Peruvian state in charge of guaranteeing, maintaining, and reestablishing internal order, providing protection and assistance to people and the community, and ensuring compliance with the security laws of the public and private assets10.
Most of these police officers have a level of psychosocial exposure unfavorable to their health in terms of insecurity, occupational stressors, such as organization (for example, staff shortages, inconsistent leadership styles), and operational elements (for example, work by turns, public scrutiny). A working schedule is 3-5 times a week, and they cannot choose their time off. Regarding physical exposure, their work demands to be standing during the entire shift of their work. This is a negative factor in terms of the posture of which it has generated some kidney problems, varicose veins, and the most common is swelling of feet. Most of the officers are unaware of active breaks; therefore, they do not take them11,12. The present objective is to determine the association of lumbar pain with anxiety and depression in police officers from a Lima police station.
METHODS
Design and study area
A descriptive, cross-sectional, analytical, and correlation study was carried out.
Population and sample
The study population was made up of the police from the Monserrat Police Station, located in Lima, Peru, during January and February 2020. All police officers who freely agreed to participate in the study were included, with prior informed consent. Exclusions included cops that were discharged, removed, and those who have had some back surgery or degenerative pathologies of any type of infectious disease, participants who are receiving physical therapy or pain relief drugs. The required sample was 110 participants, which was obtained through probability sampling.
Variables and instruments
For the measurement of lumbar pain, the instrument called a questionnaire to measure lumbar pain in police personnel ¨CDLPP¨, which consists of 12 questions, was taken into consideration presence of lumbar pain (yes/no) , chronicity of pain (acute, chronic), intensity of lumbar pain (none, mild, moderate, severe, frequency of lumbar pain (never, almost never, sometimes, almost always, always), Type of sensation of lumbar pain (numbness , burning, squeezing, stabbing, other pain), persistence of lumbar pain (less than 15 minutes, 16 to 30 minutes, 31 to 60 minutes, 1 to 2 hours), side of the lumbar region (right, left, both sides, in the center), activities increased lumbar pain (bending over, carrying light objects, being able to turn your body, carrying heavy items), limitation in the work environment (never, almost never, sometimes, almost always, always), relief of lumbar pain (rest, take medicine prescribed by the doctor, take medication without a prescription, take natural remedies, go to the specialist professional, information on lumbar pain (yes/no). This instrument validation went through expert judgment from four experts and had judges reliability of 0,914 evaluated according to Cronbach's alpha.
On the other hand, to measure anxiety, the Zung test was used, classifying anxiety as: no anxiety (normal), minimal to moderate, marked to severe and maximum grade13; ; while for the depression variable, the Zung Self-Rating Depression Scale was used, classifying depression as no depression (normal), slightly depressed, moderately depressed, severely depressed14.
Procedures
For data collection, permission was requested from the Monserrat police station commissioner; once granted, the information collection began during January and February 2020.
Statistical analysis
For the analysis, Statistical program SPSS v. 24 was used. Regarding the statistical analysis, the univariate and bivariate analysis were taken into consideration. Regarding the univariate analysis, the categorical variables (frequency and percentage) and the numerical variables (mean and standard deviation) were considered.
On the other hand, statistical parameters were taken into consideration to measure the association between categorical variables; the Chi-Square test was performed to measure the relationship between lumbar pain with anxiety and depression, significant differences were considered if the p-value it was less than 0.05.
Ethical considerations
Bioethical criteria were taken into account in scientific research (autonomy, justice, beneficence, and non-maleficence). The patients' informed consent and the institution’s permission were used to carry out the research. Likewise, respect for privacy and free participation of those investigated prior to the collection of information was guaranteed.
RESULTS
Of the total of 110 participants, 93.6% were men and 6.4% women. 50.9% of the participants declared to be married, 46.4% were single, 1.8% were divorced, and 0.9% were widowed. The average age of the participants was 38.3, with an age range of 21 to 60 years. The sociodemographic characteristics of the study sample were shown in Table 1.
Table 1. Sociodemographic characteristics of the sample of police officers from a police station in Lima 2020 (n = 110)
|
Sociodemographic characteristics |
Frequency |
Percentage |
|
Gender |
||
|
Male |
103 |
93.6 |
|
Female |
7 |
6.4 |
|
Marital status |
||
|
Single |
51 |
46.4 |
|
Married |
56 |
50.9 |
|
Divorced |
2 |
1.8 |
|
Widowed |
1 |
0.9 |
|
Age |
||
| Average ± Dev. Is it so. (min./max.) |
38,3 ± 13,9 (21 / 60) |
|
Fuente: Elaboración propia de los autores
Regarding the participants’ lumbar pain, it was obtained that 75.5% had lumbar pain while 15.5 % did not present lumbar pain. Regarding the anxiety of the participants, it was obtained that 84.5% presented a normal degree of anxiety, 13.6% showed a degree of anxiety from minimal to moderate, and 1.8% presented a degree of anxiety from marked to severe. Regarding the depression of the participants, it was obtained that 80% did not present depression, while 20% presented mild to moderate depression. Table 2 shows the results obtained from the measurement instruments applied to the population that participated in the study.
When performing the bivariate analysis on the relationship between anxiety and depression with lumbar pain, it was found that 63.6% of those surveyed with lumbar pain had a normal degree of anxiety, while 11.8% of those surveyed with lumbar pain. Lumbar pain presented a degree of minimal to moderate anxiety (p = 0.028). In addition, 60.9% of those surveyed with lumbar pain did not present depression, while 14.5% of those surveyed with lumbar pain presented mild to moderate depression (p = 0.740). The other data for analysis are found in Table 2.
Table 2. Relationship between anxiety and depression with lumbar pain in police officers from a police station in Lima (n = 110)
| Lumbar Pain | |||||||
| Yes | No | Total | |||||
| f | % | f | % | f | % | P-value | |
| Anxiety | 0,028 | ||||||
| Normal | 70 | 63,3 | 23 | 20,9 | 93 | 84,5 | |
| Minimal to moderate | 13 | 11,8 | 2 | 1,8 | 15 | 13,6 | |
| Marked to severe | 0 | 0,0 | 2 | 1,8 | 2 | 1,8 | |
| Maximum degree | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
| Depression | |||||||
| Normal | 67 | 60,9 | 21 | 19,1 | 88 | 80,0 | 0,740 |
| Slightly depressed | 16 | 14,5 | 6 | 5,5 | 22 | 20,0 | |
| Moderately depressed | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
| Severely Depressed | 0 | 0,0 | 0 | 0,0 | 0 | 0,0 | |
Source: Authors' own elaboration.
Regarding the clinical characteristics of the participants’ lumbar pain, it was found that 46.4% were chronic, 34.5 % was of moderate-intensity, 50% sometimes presented pain, 17.3% pain was puncture type and 30% presented pain on both sides. Table 3 details the results obtained from the measurement instrument applied to the population that participated in the study.
Table 3. CClinical characteristics of lumbar pain in police officers from a police station in Lima (n = 83)
|
Characteristic of lumbar pain |
Frequency |
Percentage |
|
Chronicity |
||
|
Acute |
32 |
29.1 |
|
Chronic |
51 |
46.4 |
|
Intensity |
||
|
Mild |
35 |
31.8 |
|
Moderate |
38 |
34.5 |
|
Severe |
10 |
9.1 |
|
Frequency of pain |
||
|
Rarely |
10 |
9.1 |
|
Sometimes |
55 |
50.0 |
|
Almost always |
15 |
13.6 |
|
Always |
3 |
2.7 |
|
Type pain |
||
|
Numbness |
18 |
16.4 |
|
Burning |
17 |
15.5 |
|
Constricting |
17 |
15.5 |
|
Pungent |
19 |
17.3 |
|
Other |
12 |
10.9 |
|
Side of pain |
||
|
Right |
8 |
7.3 |
|
Left |
11 |
10.0 |
|
Both sides |
33 |
30.0 |
|
In the center |
31 |
28.2 |
Source: Authors' own elaboration.
DISCUSSION
Musculoskeletal disorders are considered a major problem affecting the health and well-being of active-duty police. Discomfort from wearing mandatory equipment and sitting for long periods in fleet vehicles are workload factors related to musculoskeletal disorders in the police13.
Regarding lumbar pain, 75.5% of police officers present lumbar pain. This agrees with several previous reports Cardoso E14, Brown JJ15, Gruevski KM16. This problem is severe and frequent in police personnel17. While it is true, the police’s activity is exposed to a series of factors that could affect their health and produce physical disability. Some carry out internal functions such as administrative activities, others patrol, standing for many hours, and carrying heavy equipment. Adding the working conditions, can lead to an overload of the column18.
Regarding anxiety and its relationship with lumbar pain (p = 0.028), studies such as Douma NB19. This agrees with several previous reports Santiago C20, Barreda E21. Likewise, anxiety and depression disorders are increasingly affecting society. Anxiety disorders are the most common psychiatric disorders, and depressive disorders are increasing in society globally. Lumbar pain is one of the common health problems experienced by 50-80% of adults at some point in their lives22.
Regarding depression, a study by Jara JA23. People with symptoms of depression are at higher risk of developing an episode of lumbar pain in the future, with the risk being higher in patients with more severe levels of depression24. Anxious manifestations accompany this high proportion of depressive disorders, and these frequently present with pain. Likewise, these painful manifestations cause or worsen depressive and anxious symptoms25.
On the other hand, the individual’s psychological aspects are important in the development and progression of lumbar pain. It is important to consider that the official personnel, in the presence of pain, rest, and take medications prescribed by the specialist, similar to a study mentioned by Anderson G26. Likewise, back pain is a factor to increase the probability of depression27.
This type of Investigation in police personnel is of utmost importance, because of the characteristics demanded by their work in the development of their functions. They are exposed to physical and functional injury, and in their emotional state, problems could hinder missions. Early detection could avoid any kind of subsequent consequences.
Despite the present research, which was supported by the participants. It had limitations, including the little and scarce national background information about lumbar pain publications in police personnel. Likewise, he may have had a recall or memory bias when completing the questionnaire alternatives, to recall experiences accurately.
CONCLUSION
Lumbar pain is associated with anxiety in police officers at a police station in Lima. Likewise, a high percentage of police officers who suffer from lumbar pain consider it a public health problem, which could lead to some type of disability in the future, affecting their quality of life.
Author’s contributions: The authors that participated in the genesis of the idea, project design, development, data collection, and interpretation, results in analysis, and manuscript preparation.
Funding: The work is self-financed by the authors.
Conflicts of interest: The authors declare that they have no conflicts of interest.
Received: October 1, 2020.
Accepted: December 4, 2020.
Correspondence: Cristhian Santiago Bazan
Address: Jr. Tiahuanaco 1493 Urb. Zárate S.J.L., Lima-Perú.
Telephone: 997602814
E-mail: cristhiansantiagob@gmail.com
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