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

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

23 Citations (Scopus)



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.

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).

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.

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
Issue number3
Publication statusPublished - Sept 2015

Bibliographical 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.


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


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