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Affiliation
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1MSC10 5600, 1 University of New Mexico, Albuquerque, NM 87131 2Atlanta Medical Center, 303 Parkway Drive SE, Atlanta, GA 30312 3Gwinnett Medical Center, c/o Janet Schwalbe, 1000 Medical Center Dr., Lawrenceville, GA, 30046. |
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Abstract
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OBJECTIVES:: This study prospectively followed a cohort of orthopaedic trauma patients in order to identify risk factors that contribute to depression in patients with skeletal injuries.
DESIGN:: Prospective Cohort Study SETTING:: Level I Trauma Center PATIENTS:: 110 orthopedic trauma patients admitted as inpatients. INTERVENTION:: None MAIN OUTCOME MEASUREMENTS:: Patient Health Questionnaire (PHQ-9) scores RESULTS:: 110 patients were enrolled at the time of injury in which 22 patients had moderate to major depression and 36 patients had mild depression. 48 patients completed the follow up surveys which were taken, on average, 9 months after the date of injury. Factors that were significant for mild depression (PHQ-9 > 4) at the time of injury included a history of illegal drug use (p=0.037) and a lower Duke Social Support and Stress Scale (DUSOCS) support score (p=0.002). The DUSOCS score had a negative Pearson Correlation Coefficient with PHQ-9 (n=-0.18, p=0.03). Factors that were significant for moderate to major depression (PHQ-9 > 9) at time of injury were a history of a psychiatric diagnosis (P=0.0009) and unemployment at injury (p=0.039). Both a history of psychiatric diagnosis and an elevated PHQ-9 score at the time of injury were predictors of having depression at 9 months (p=0.02 and p=0.001 respectively). Also, patients with Medicaid insurance had a significant increase in their depression scores at 9 months (p=0.02).
CONCLUSION:: Depression was quite prevalent in our patient sample. A prior psychiatric diagnosis predisposed patients to depression. Socioeconomic status was also a predictive factor for increased depression scores at 9 months. Patients with a higher feeling of support from friends and family had an inverse correlation for depression. Employment also appears to have a protective effect against depression. Surprisingly, the severity of injury did not affect the depression score. Targeted consultation with a mental health care provider may obviate any morbidity associated with depression in an injured patient. LEVEL OF EVIDENCE:: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Language: en |