The Link Between Depression, Analgesia Usage and Function in Osteoarthritis: A Propensity Score-Matched Analysis from the Osteoarthritis Initiative Cohort

Knee osteoarthritis (OA) affects around 37% of U.S. adults over 60, with over 25% experience depressive symptoms (DSs), linked to worse pain and outcomes. Yet their impact on analgesic use and recovery remains unclear. This study aimed to assess if DSs influence analgesic use and functional outcomes in knee OA. Using data from the Osteoarthritis Initiative (n = 3680), we used a Machine Learning (ML)-based Gradient Boosting Machine (GBM) model to perform propensity score matching, matching patients with knee OA and DSs (n = 487) to those without DSs (n = 487). Outcomes at baseline, 1 and 2 years included analgesic use, function (WOMAC), quality of life (KOOS-QoL), and physical health (SF-12 PCS). Regression and timepoint models compared follow-up with baseline. DSs alone were not associated with greater opioid use up to Year 2 (OR = 0.89, 95% CI: 0.45–1.73; p = 0.73). Among patients with DSs, SF-12 PCS improvement was less likely at Year 1, while decline was more likely up to Year 2. DSs in OA were linked to poorer physical health, but often greater functional gains than those in OA without DSs, with no difference in opioid use. These findings highlight the need for multidisciplinary strategies, addressing both pain and psychosocial wellbeing.