Objectives: To document the prevalence and impact on health related outcomes of co-morbid pain and depression among elders residing in community settings.

Methods: Depression symptoms (Geriatric Depression Score,GDS), pain (adapted from the McGill Pain Questionnaire), illness level, physical functioning, self-rated health, and health service use were measured during in-person interviews with 706 independently living Caucasian and African American elders (mean age 74, sd 7.2).   Individuals were classified as: “no depression” (GDS scores <6),  “mild distress”  (GDS scores >5 - <11), “sub-threshold, minor, or major depression” (GDS >10) and “no pain”, “pain without activity limitations”, or “pain with activity limitations’.

Results:   Co-morbid pain and depression (“pain with activity limitations” and “sub-threshold, minor, or major depression”) was observed in 23.3% of the sample. Compared to all others, the odds of being in the poorest physical function quartile was 4.2 (95% CI 2.9 – 6.0) times greater for co-morbid pain/depression group members. Such individuals were 5.6 (95% CI 4.1 – 7.8) times more likely to report fair or poor health.  They reported, on average, almost twice as many doctor visits over 12 months.  The impact of co-morbid pain and depression remained statistically significant (p<.01) after controlling for illness level, the main potential confounder.

Conclusions: The data reveal co-morbid pain and depression increases health status compromise as well as use of costly health services. The substantial proportion of older, community residing individuals affected requires its recognition as a public health problem and its correction with focused prevention and intervention activities.