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OBJECTIVE: Distinguishing transient from persistent anxiety and depression symptoms in older people presenting to general practice with musculoskeletal pain is potentially important for effective management. This study sought to identify distinct post-consultation depression and anxiety symptom trajectories in adults aged over 50years consulting general practice for non-inflammatory musculoskeletal pain. METHODS: Self-completion questionnaires, containing measures of anxiety and depressive symptoms, age, gender, pain status, coping and social status were mailed within 1week of the consultation and at 3, 6 and 12months. Latent class growth analysis was used to identify anxiety and depression symptoms trajectories, which were ascertained with cut-off score ≥8 on Hospital Anxiety and Depression Scale subscales. Associations between baseline characteristics and cluster membership were examined using multivariate multinomial logistic regression analysis (the 3-step approach). RESULTS: Latent class growth analyses determined a 3-cluster anxiety model (n=499) and a 3-cluster depression model (n=501). Clusters identified were: no anxiety problem (44.1%), persistent anxiety problem (33.9%) and transient anxiety symptoms (22.2%); no depression problem (74.1%), persistent depression problem (22.0%) and gradual depression symptom recovery (4.0%). Widespread pain, interference with valued activities, coping by increased behavioral activities, catastrophizing, perceived lack of instrumental support, age ≥70years, being female, and performing manual/routine work were associated with anxiety and/or depression clusters. CONCLUSIONS: Older people with non-inflammatory musculoskeletal pain are at high risk of persistent anxiety and/or depression problems. Biopsychosocial factors, such as pain status, coping strategies, instrumental support, performing manual/routine work, being female and age ≥70years, may help identify patients with persistent anxiety and/or depression.

Original publication




Journal article


J psychosom res

Publication Date





195 - 201


Anxiety, Depression, General practice, Musculoskeletal pain, Older adult, Trajectory, Adaptation, Psychological, Adult, Age Factors, Aged, Aged, 80 and over, Anxiety, Depression, Female, General Practice, Humans, Male, Middle Aged, Musculoskeletal Pain, Office Visits, Psychiatric Status Rating Scales, Risk Factors, Severity of Illness Index, Sex Factors, Task Performance and Analysis