Depression and anxiety coexisting with osteoarthritis in primary care: from recognition to management

Abstract

Osteoarthritis (OA), depression and anxiety are common problems in primary care. OA coexisting with depressive and/or anxiety symptoms has detrimental consequences to the individual. To inform recognition and management of these important problems in primary care a better understanding of their coexistence is needed.
A systematic review with meta-analysis was undertaken to determine the prevalence of depression and anxiety in adults with OA/joint pain in the community. Elevated anxiety symptoms were more common (45%) than depression symptoms (24%) in persons with OA joint pain. Sources of between study variance include methods of ascertainment and geographical location. A review of measurement properties of several recommended patient-reported depression and anxiety measures found evidence to support properties in some populations, but some critical properties warrant investigation in adults with OA in the community.
A secondary data analysis was conducted for older consecutive primary care patients with musculoskeletal pain recruited to a cohort (n=443) of the PROGnostic Research study. Latent Class Growth Analyses identified clusters of individuals who exhibited different trajectories of anxiety and depression symptoms over a 12-month period: three anxiety and two depression symptom trajectories. In total, 56% and 63% of participants experienced persistent anxiety and depression symptoms respectively for at least 12 months. Pain characteristics and coping strategies were the most prominent risk factors for persistent anxiety and depression symptoms. With the aim of identifying individuals with sub- threshold persistent anxiety and depression symptoms, characteristics predisposing to symptoms persistence may be considered.
A medical records review found that only half of all older musculoskeletal patients with persistent anxiety and depression symptoms have their mental health problems detected by their GP. Frequent consulters and those with more severe anxiety were more likely to be detected. This reinforces the need to recognise and manage OA coexisting with depression and/or anxiety by patients and health professionals alike.