One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain

a latent class growth analysis

Magdalena Rzewuska (Corresponding Author), Christopher J Mallen, Victoria S Strauss, John Belcher, George Peat

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

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 50 years 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 1 week of the consultation and at 3, 6 and 12 months. 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 ≥ 70 years, 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 ≥ 70 years, may help identify patients with persistent anxiety and/or depression.
Original languageEnglish
Pages (from-to)195-201
Number of pages7
JournalJournal of Psychosomatic Research
Volume79
Issue number3
DOIs
Publication statusPublished - Sep 2015

Fingerprint

Musculoskeletal Pain
General Practice
Anxiety
Depression
Growth
Pain
Referral and Consultation
Catastrophization

Keywords

  • musculoskeletal pain
  • older adult
  • depression
  • anxiety
  • trajectory
  • primary care

Cite this

One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain : a latent class growth analysis. / Rzewuska, Magdalena (Corresponding Author); Mallen, Christopher J; Strauss, Victoria S; Belcher, John; Peat, George.

In: Journal of Psychosomatic Research, Vol. 79, No. 3, 09.2015, p. 195-201.

Research output: Contribution to journalArticle

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title = "One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain: a latent class growth analysis",
abstract = "ObjectiveDistinguishing 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 50 years consulting general practice for non-inflammatory musculoskeletal pain.MethodsSelf-completion questionnaires, containing measures of anxiety and depressive symptoms, age, gender, pain status, coping and social status were mailed within 1 week of the consultation and at 3, 6 and 12 months. 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).ResultsLatent 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 ≥ 70 years, being female, and performing manual/routine work were associated with anxiety and/or depression clusters.ConclusionsOlder 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 ≥ 70 years, may help identify patients with persistent anxiety and/or depression.",
keywords = "musculoskeletal pain, older adult, depression, anxiety, trajectory, primary care",
author = "Magdalena Rzewuska and Mallen, {Christopher J} and Strauss, {Victoria S} and John Belcher and George Peat",
note = "Magdalena Rzewuska was funded by the University of Keele Acorn studentship. Christian Mallen is funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands, the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice (NIHR-RP-2014-04-026). The PROG-RES study was supported by the North Staffordshire NHS Primary Care Research Consortium and Arthritis Research UK.",
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T1 - One-year trajectories of depression and anxiety symptoms in older patients presenting in general practice with musculoskeletal pain

T2 - a latent class growth analysis

AU - Rzewuska, Magdalena

AU - Mallen, Christopher J

AU - Strauss, Victoria S

AU - Belcher, John

AU - Peat, George

N1 - Magdalena Rzewuska was funded by the University of Keele Acorn studentship. Christian Mallen is funded by the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care West Midlands, the NIHR School for Primary Care Research and an NIHR Research Professorship in General Practice (NIHR-RP-2014-04-026). The PROG-RES study was supported by the North Staffordshire NHS Primary Care Research Consortium and Arthritis Research UK.

PY - 2015/9

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N2 - ObjectiveDistinguishing 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 50 years consulting general practice for non-inflammatory musculoskeletal pain.MethodsSelf-completion questionnaires, containing measures of anxiety and depressive symptoms, age, gender, pain status, coping and social status were mailed within 1 week of the consultation and at 3, 6 and 12 months. 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).ResultsLatent 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 ≥ 70 years, being female, and performing manual/routine work were associated with anxiety and/or depression clusters.ConclusionsOlder 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 ≥ 70 years, may help identify patients with persistent anxiety and/or depression.

AB - ObjectiveDistinguishing 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 50 years consulting general practice for non-inflammatory musculoskeletal pain.MethodsSelf-completion questionnaires, containing measures of anxiety and depressive symptoms, age, gender, pain status, coping and social status were mailed within 1 week of the consultation and at 3, 6 and 12 months. 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).ResultsLatent 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 ≥ 70 years, being female, and performing manual/routine work were associated with anxiety and/or depression clusters.ConclusionsOlder 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 ≥ 70 years, may help identify patients with persistent anxiety and/or depression.

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KW - older adult

KW - depression

KW - anxiety

KW - trajectory

KW - primary care

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DO - 10.1016/j.jpsychores.2015.05.016

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VL - 79

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JO - Journal of Psychosomatic Research

JF - Journal of Psychosomatic Research

SN - 0022-3999

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ER -