Orthopaedic trauma patients and depression: a prospective cohort

J Orthop Trauma. 2014 Oct;28(10):e242-6. doi: 10.1097/BOT.0000000000000128.


Objectives: This study prospectively followed a cohort of orthopaedic trauma patients to identify risk factors that contribute to depression in patients with skeletal injuries.

Design: Prospective cohort study.

Setting: Level I trauma center.

Patients: One hundred ten orthopaedic trauma patients admitted as inpatients.

Intervention: None.

Main outcome measurements: Patient Health Questionnaire (PHQ-9) scores.

Results: One hundred ten patients were enrolled at the time of injury in which 22 patients had moderate-to-major depression and 36 patients had mild depression. Forty-eight patients completed the follow-up surveys that 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 duke social support and stress scale 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 the 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 previous psychiatric diagnosis predisposed patients to depression. The 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 seems 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 that is 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.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Depressive Disorder / complications*
  • Female
  • Humans
  • Inpatients
  • Male
  • Middle Aged
  • Musculoskeletal System / injuries*
  • Prospective Studies
  • Risk Factors
  • Trauma Centers
  • Wounds and Injuries / complications
  • Wounds and Injuries / psychology*
  • Wounds and Injuries / therapy
  • Young Adult