Depressed patients with a history of back pain are more susceptible to back pain recurrence, according to a recent study published in the journal Pain. While the correlation has been evident for years, researchers ran into the “chicken-or-the-egg” issue: Does depression cause back pain, or does back pain cause depression? While a gray area remains, depression was specifically identified as an independent risk factor for back pain.

Researchers collected information from 790 patients who had suffered back pain but were symptom-free at the beginning of the study. Over the next year, researchers documented that because both conditions are very common and can come and go, depression and back pain could develop into a vicious cycle.

These findings are corroborated by a study published late last year in the Journal of the American Medical Association that revealed those suffering from depression and arthritis had more favorable outcomes when undergoing a personalized program for depression treatment, with options for antidepressant medications and psychotherapy.

“We’re wondering if depression leads people to cope passively when they experience the kinds of mild pain episodes that most of us are periodically subjected to,” says back-pain study author Linda J. Carroll, Ph.D. “This, in turn, may increase the likelihood that pain will become a problem in someone’s life.”