Background: Patients (pts) with multiple myeloma (MM) experience physical symptoms and complications from disease or treatment that include bone pain, fatigue, anorexia, and insomnia. However, the prevalence of psychiatric comorbidities and their impact on short and long-term outcomes has been understudied. The aim of this analysis was to identify the prevalence of anxiety and depression in older pts with MM in the state of North Carolina. We also sought to evaluate if comorbid depression and anxiety impacted short and long-term outcomes in these patients. Methods: Using the University of North Carolina Integrated Cancer Information and Surveillance System (ICISS), we retrospectively identified a statewide cohort of 536 pts (ages 65-80) diagnosed with MM from 2006-2012 who had continuous enrollment in Medicare or Medicaid. Patients were identified through insurance claims by ICD-9 diagnosis codes for anxiety or depression or antidepressant medications filed at any time from 6 months prior to MM diagnosis to 12 months after MM diagnosis. Results: The mean age of pts in the cohort was 72 years. Pts were 68% non-Hispanic white, 42% rural, and 51% male. Of the 536 pts, 200 (37%) had a diagnosis of anxiety or depression and/or were being treated with an antidepressant. 54% of those with psychiatric comorbidity had a relevant diagnosis or medication in the 6 months prior to MM diagnosis. Of those with psychiatric comorbidities, 70% were diagnosed with fatigue and 57% were diagnosed with pain. In multivariate analysis, there was no association of psychiatric comorbidity with mortality (HR, 1.03; 95% CI, 0.83-1.28), but psychiatric comorbidity was associated with an increased likelihood of hospitalization or ER visit (RR, 1.17; 95% CI, 1.05-1.30) and increased opiate use within 1 year after diagnosis (RR, 1.66; 95% CI, 1.27-2.16). Conclusions: The presence of psychiatric comorbidity identifies a subset of older MM pts at risk for high symptom burden and increased health care utilization. The association of psychiatric comorbidity with increased opiate use in cancer pts may also have public health implications.