Authors' response

Comorbid depression in older people is an important clinical topic that, to date, has failed to receive the attention it deserves. We welcome the findings reported by Suija et al, which provide further evidence that depressive comorbidity is common in older people with musculoskeletal pain.

It is perhaps not surprising that different results were found between the two studies. Our study¹ found that just over a third of older primary care consulters with musculoskeletal pain had depressive symptoms measured using the Hospital Anxiety and Depression Scale² whereas Suija et al used the Composite International Diagnostic Interview, finding that 23.8% of participants had a depression diagnosis.

Suija et al comment that the majority of older people with musculoskeletal pain are non-depressed. While this is true for both studies, the high level of either depressive symptoms or diagnoses remains clinically important. A prevalence of comorbid depression of around 25% is consistent with those reported for other conditions, such as diabetes and coronary heart disease. The importance of detecting and adequately treating depression for these conditions is well documented. Since comorbid depression is consistently associated with a poor prognosis for musculoskeletal pain³ we strongly feel that a holistic approach, which includes an assessment of depressive symptoms and severity, should be taken to ensure high-quality patient care and improved patient outcomes.