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Background  Multi-morbidity in older adults is commonly associated with depressed mood. Similarly, subjective reports of pain are also associated with both physical illness and increased depressive symptoms. However, whether pain independently contributes to the experience of depression in older people with multi-morbidity has not been studied.    Methods  In this study, participants were 1281 consecutive older adults presenting to one of 19 primary care services in Australia (recruitment rate = 75%). Participants were asked to indicate the presence of a number of common chronic illnesses, to rate their current pain severity and to complete the Geriatric Depression Scale.    Results  Results confirmed that the number of medical illnesses reported was strongly associated with depressive symptoms. Twenty-six percent of participants with multi-morbidity scored in the clinical range for depressive symptoms in comparison to 15% of participants with no illnesses or a single illness. In regression analyses, the presence of chronic pain ( t  = 5.969,  p  < 0.0005), diabetes ( t  = 4.309,  p  < 0.0005), respiratory ( t  = 3.720,  p  < 0.0005) or neurological illness ( t  = 2.701,  p  = 0.007) were all independent contributors to depressive symptoms. Even when controlling for each individual illness, and the overall number of illnesses ( t  = 2.207,  p  = 0.028), pain severity remained an independent predictor of depressed mood (F change = 28.866,  p  < 0.0005,  t  = 5.373,  p  < 0.0005).    Conclusions  Physicians should consider screening for mood problems amongst those with multi-morbidity, particularly those who experience pain.

Pain severity predicts depressive symptoms over and above individual illnesses and multimorbidity in older adults