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Screening older people with musculoskeletal pain for depressive symptoms in primary care
Christian David Mallen1, George Peat
1Arthritis Research Campaign National Primary Care Centre, Keele University, Keele, Staffordshire. c.d.mallen@cphc.keele.ac.uk
Background:
Older patients presenting to GPs with musculoskeletal pain are at high risk of having concurrent depression.
Aim:
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.
Design Of Study:
Cross-sectional survey, linked GP consultation data.
Setting:
General practices in central Cheshire, UK.
Method:
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.
Conclusion:
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.
