Screening older people with musculoskeletal pain for depressive symptoms in primary care.
BACKGROUND
Older patients presenting to GPs with musculoskeletal pain are at high risk of having concurrent depression.


OBJECTIVE
To investigate the performance of ultra-short (1-4 items tools) screening questions used during the consultation, and through a patient questionnaire to detect depressive symptoms among older adults presenting with musculoskeletal pain to general practice.


METHODS
Cross-sectional survey, linked GP consultation data.


METHODS
General practices in central Cheshire, UK.


METHODS
Consecutive patients aged > or =50 years presenting with non-inflammatory musculoskeletal pain were eligible to participate. GPs screened all patients in the consultation for the presence of depressive symptoms using two questions. All patients were sent a postal questionnaire within 1 week of consultation containing the Hospital Anxiety and Depression Scale and the written version of the depression screening questions.


RESULTS
The total number of patients included in the study was 428. In total, 35.5% of consulters had comorbid depressive symptoms, with 13.5% experiencing moderate or severe symptoms. Just over half of participants (n = 218/242; 51.4%) screened positive on self-administered screening at home compared with only 78 (20.8%) on GP-administered screening in the consultation. There was little difference between GP-administered and self-administered screening in the probability of depressive symptoms among those who screened positive with regard to exhibiting signs of having depressive symptoms.


CONCLUSIONS
Older patients consulting their GP with musculoskeletal pain frequently have comorbid mental ill health. Ultrashort depression screening questions administered during the consultation miss a large number of those with depressive symptoms, including six out of eight patients with severe symptoms. An improvement in the performance of screening questions in this patient group or narrowing the definition of 'high risk' from all patients aged > or =50 years presenting with musculoskeletal pain could help to improve detection.
Mallen
Christian David
CD
Arthritis Research Campaign National Primary Care Centre, Keele University, Keele, Staffordshire. c.d.mallen@cphc.keele.ac.uk
Peat
George
G
D000368:Aged; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000175:diagnosis* / Q000209:etiology; D005194:Family Practice / Q000592:standards*; D015577:Geriatric Assessment; D006801:Humans; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications / Q000523:psychology*; D010146:Pain / Q000150:complications / Q000523:psychology*; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires