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: 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.
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, UK; The George Institute for Global Health, Sydney Medical School, Sydney, NSW, Australia; Ribeirão Preto Medical School, Community Health Postgraduate Program, University of São Paulo, Brazil. Electronic address: mrzewuska@georgeinstitute.org.au.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Rzewuska
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, UK.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Mallen
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, UK; Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
authors.forename: Victoria Y
authors.initials: VY
authors.lastname: Strauss
authors.affiliation: The George Institute for Global Health, Sydney Medical School, Sydney, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Belcher
authors.affiliation: Arthritis Research UK Primary Care Centre, Keele University, UK.
authors.forename: George
authors.initials: G
authors.lastname: Peat
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000209:etiology*; D003863:Depression / Q000209:etiology*; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D059352:Musculoskeletal Pain / Q000523:psychology*; D009819:Office Visits; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012720:Severity of Illness Index; D012737:Sex Factors; D013647:Task Performance and Analysis
keywords: Anxiety; Depression; General practice; Musculoskeletal pain; Older adult; Trajectory