Toward an integrated biopsychosocial approach for older adults with knee osteoarthritis: The impact of depression and anxiety on pain intensity

Int J Orthop Trauma Nurs. 2026 Mar 30;61:101281. doi: 10.1016/j.ijotn.2026.101281. Online ahead of print.

ABSTRACT

BACKGROUND: Knee osteoarthritis (KOA) is a major cause of chronic pain, disability, and reduced quality of life among older adults. Evidence suggests that the severity of pain in KOA does not always correspond with radiographic joint damage, indicating that psychological factors may play an important role in shaping the pain experience.

AIM: This study aimed to examine whether depression and anxiety independently predict pain intensity in older adults with knee osteoarthritis, supporting the need for an integrated biopsychosocial approach to pain management.

METHODS: A descriptive cross-sectional study was conducted with 300 older adults (≥60 years) diagnosed with KOA at orthopedic outpatient clinics (January-June 2024). Data were collected via face-to-face interviews using the Wong-Baker FACES Pain Rating Scale, Geriatric Depression Scale-Short Form, and Beck Anxiety Inventory. Multiple linear regression and Pearson correlation analyses were used to identify psychological predictors of pain intensity.

RESULTS: Depression and anxiety were significant independent predictors of pain intensity. Depression demonstrated the strongest association with pain (β = 0.48, p < 0.001), followed by anxiety (β = 0.21, p = 0.035). Body mass index was not significantly associated with pain intensity.

CONCLUSION: Psychological distress plays a significant role in the pain experience of older adults with knee osteoarthritis. These findings highlight the importance of integrating psychological assessment into routine care. Orthopedic and trauma nurses play a crucial role in screening for depression and anxiety, implementing biopsychosocial pain management strategies, and coordinating interdisciplinary care to improve outcomes for older adults with knee osteoarthritis.

PMID:41955780 | DOI:10.1016/j.ijotn.2026.101281