Scientific article| Volume 45, ISSUE 2, P159.e1-159.e8, February 2020

The Association Between Symptoms of Depression and Office Visits in Patients With Nontraumatic Upper-Extremity Illness


      Because psychological and social factors increase symptoms and limitations, it is possible that they are also related to higher use of care.


      We used a database of an academic outpatient orthopedic department in which patient-reported outcome measures were routinely collected and identified 3,620 patients with de Quervain tendinopathy, ganglion, trapeziometacarpal arthritis, trigger digit, or carpal tunnel syndrome who remained in care at least 3 months. At every office visit, patients completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function Computerized Adaptive Test (CAT), PROMIS Pain Interference CAT, and PROMIS Depression CAT. We conducted multivariable Poisson regression analysis of factors associated with the total number of office visits, accounting for PROMIS scores at the first office visit, age, surgical treatment, sex, diagnosis, and clinician team.


      Operative treatment had the greatest influence on the number of office visits. Other variables associated with the number of visits were female sex, younger age, higher PROMIS Depression scores, and higher Pain Interference scores.


      Treatment choice had the greatest influence on the number of subsequent visits for atraumatic conditions. The fact that the total number of office visits is associated with greater symptoms of depression and greater pain interference, independent of treatment choice, suggests a relation between mental health and resource use.

      Clinical relevance

      Quality improvement efforts and future research might address whether adding strategies to decrease symptoms of depression and optimize coping strategies (to reduce pain interference) might improve upper-extremity health more efficiently than standard treatment alone.

      Key words

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        • Melamed E.
        • Marascalchi B.
        • Hinds R.M.
        • Rizzo M.
        • Capo J.T.
        Trends in the utilization of total wrist arthroplasty versus wrist fusion for treatment of advanced wrist arthritis.
        J Wrist Surg. 2016; 5: 211-216
        • Foster B.D.
        • Sivasundaram L.
        • Heckmann N.
        • et al.
        Surgical approach and anesthetic modality for carpal tunnel release: a nationwide database study with health care cost implications.
        Hand (N Y). 2017; 12: 162-167
        • Iordache S.D.
        • Rowan R.
        • Garvin G.J.
        • Osman S.
        • Grewal R.
        • Faber K.J.
        Prevalence of triangular fibrocartilage complex abnormalities on MRI scans of asymptomatic wrists.
        J Hand Surg Am. 2012; 37: 98-103
        • Kachooei A.R.
        • Nota S.P.
        • Menendez M.E.
        • Dyer G.S.
        • Ring D.
        Factors associated with operative treatment of de Quervain tendinopathy.
        Arch Bone Jt Surg. 2015; 3: 198-203
        • Kachooei A.R.
        • Talaei-Khoei M.
        • Faghfouri A.
        • Ring D.
        Factors associated with operative treatment of enthesopathy of the extensor carpi radialis brevis origin.
        J Shoulder Elbow Surg. 2016; 25: 666-670
        • Becker S.J.
        • Makarawung D.J.
        • Spit S.A.
        • King J.D.
        • Ring D.
        Disability in patients with trapeziometacarpal joint arthrosis: incidental versus presenting diagnosis.
        J Hand Surg Am. 2014; 39: 2009-2015.e8
        • Jain N.B.
        • Higgins L.D.
        • Losina E.
        • Collins J.
        • Blazar P.E.
        • Katz J.N.
        Epidemiology of musculoskeletal upper extremity ambulatory surgery in the United States.
        BMC Musculoskelet Disord. 2014; 15: 4
        • Brown III, G.D.
        • Roh M.S.
        • Strauch R.J.
        • Rosenwasser M.P.
        • Ateshian G.A.
        • Mow V.C.
        Radiography and visual pathology of the osteoarthritic scaphotrapezio-trapezoidal joint, and its relationship to trapeziometacarpal osteoarthritis.
        J Hand Surg Am. 2003; 28: 739-743
        • Zingg P.O.
        • Jost B.
        • Sukthankar A.
        • Buhler M.
        • Pfirrmann C.W.
        • Gerber C.
        Clinical and structural outcomes of nonoperative management of massive rotator cuff tears.
        J Bone Joint Surg Am. 2007; 89: 1928-1934
        • Teunis T.
        • Lubberts B.
        • Reilly B.T.
        • Ring D.
        A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age.
        J Shoulder Elbow Surg. 2014; 23: 1913-1921
        • Liu T.C.
        • Leung N.
        • Edwards L.
        • Ring D.
        • Bernacki E.
        • Tonn M.D.
        Patients older than 40 years with unilateral occupational claims for new shoulder and knee symptoms have bilateral MRI changes.
        Clin Orthop Relat Res. 2017; 475: 2360-2365
        • Stoop N.
        • van der Gronde B.A.T.D.
        • Janssen S.J.
        • Kuntz M.T.
        • Ring D.
        • Chen N.C.
        Incidental flexor carpi radialis tendinopathy on magnetic resonance imaging.
        Hand (N Y). 2019; 14: 632-635
        • Yeoh J.C.
        • Pike J.M.
        • Slobogean G.P.
        • O’Brien P.J.
        • Broekhuyse H.M.
        • Lefaivre K.A.
        Role of depression in outcomes of low-energy distal radius fractures in patients older than 55 years.
        J Orthop Trauma. 2016; 30: 228-233
        • Wright M.A.
        • Beleckas C.M.
        • Calfee R.P.
        Mental and physical health disparities in patients with carpal tunnel syndrome living with high levels of social deprivation.
        J Hand Surg Am. 2019; 44: 335.e1-335.e9
        • Beleckas C.M.
        • Wright M.
        • Prather H.
        • Chamberlain A.
        • Guattery J.
        • Calfee R.P.
        Relative prevalence of anxiety and depression in patients with upper extremity conditions.
        J Hand Surg Am. 2018; 43: 571.e1-571.e8
        • Beleckas C.M.
        • Guattery J.
        • Chamberlain A.M.
        • Khan T.
        • Kelly M.P.
        • Calfee R.P.
        Using Patient-Reported Outcomes Measurement Information System measures to understand the relationship between improvement in physical function and depressive symptoms.
        J Am Acad Orthop Surg. 2018; 26: e511-e518
        • London D.A.
        • Stepan J.G.
        • Boyer M.I.
        • Calfee R.P.
        The impact of depression and pain catastrophization on initial presentation and treatment outcomes for atraumatic hand conditions.
        J Bone Joint Surg Am. 2014; 96: 806-814
        • Bernstein D.N.
        • Houck J.R.
        • Gonzalez R.M.
        • et al.
        Preoperative PROMIS scores predict postoperative PROMIS score improvement for patients undergoing hand surgery [published online ahead of print August 3, 2018]. Hand (N Y).
        • Kohring J.M.
        • Erickson J.A.
        • Anderson M.B.
        • Gililland J.M.
        • Peters C.L.
        • Pelt C.E.
        Treated versus untreated depression in total joint arthroplasty impacts outcomes.
        J Arthroplasty. 2018; 33: S81-S85
        • Fischerauer S.F.
        • Talaei-Khoei M.
        • Vissers F.L.
        • Chen N.
        • Vranceanu A.-M.
        Pain anxiety differentially mediates the association of pain intensity with function depending on level of intolerance of uncertainty.
        J Psychiatr Res. 2018; 97: 30-37
        • Crijns T.J.
        • Bernstein D.N.
        • Ring D.
        • Gonzalez R.M.
        • Wilbur D.
        • Hammert W.C.
        Depression and pain interference correlate with physical function in patients recovering from hand surgery.
        Hand (N Y). 2019; 14: 830-835
        • Kortlever J.T.P.
        • Janssen S.J.
        • van Berckel M.M.G.
        • Ring D.
        • Vranceanu A.M.
        What is the most useful questionnaire for measurement of coping strategies in response to nociception?.
        Clin Orthop Relat Res. 2015; 473: 3511-3518
        • Suso-Ribera C.
        • Garcia-Palacios A.
        • Botella C.
        • Ribera-Canudas M.V.
        Pain catastrophizing and its relationship with health outcomes: does pain intensity matter?.
        Pain Res Manag. 2017; 2017: 9762864
        • Goesling J.
        • Brummett C.M.
        • Meraj T.S.
        • Moser S.E.
        • Hassett A.L.
        • Ditre J.W.
        Associations between pain, current tobacco smoking, depression, and fibromyalgia status among treatment-seeking chronic pain patients.
        Pain Med. 2015; 16: 1433-1442
        • McDermott K.A.
        • Joyner K.J.
        • Hakes J.K.
        • Okey S.A.
        • Cougle J.R.
        Pain interference and alcohol, nicotine, and cannabis use disorder in a national sample of substance users.
        Drug Alcohol Depend. 2018; 186: 53-59
        • Schalet B.D.
        • Hays R.D.
        • Jensen S.E.
        • Beaumont J.L.
        • Fries J.F.
        • Cella D.
        Validity of PROMIS physical function measured in diverse clinical samples.
        J Clin Epidemiol. 2016; 73: 112-118
        • Amtmann D.
        • Cook K.F.
        • Jensen M.P.
        • et al.
        Development of a PROMIS item bank to measure pain interference.
        Pain. 2010; 150: 173-182
        • Schalet B.D.
        • Pilkonis P.A.
        • Yu L.
        • et al.
        Clinical validity of PROMIS Depression, Anxiety, and Anger across diverse clinical samples.
        J Clin Epidemiol. 2017; 73: 119-127
        • PROMIS
        A brief guide to the PROMIS Physical Function instruments: physical function.
        (Available at:)
        • Crijns T.J.
        • Bernstein D.N.
        • Ring D.
        • Gonzalez R.
        • Wilbur D.
        • Hammert W.C.
        Factors associated with a discretionary upper-extremity surgery.
        J Hand Surg Am. 2019; 44 (155.e1–e7)
        • Wilkens S.C.
        • Ring D.
        • Teunis T.
        • Lee S.-G.P.
        • Chen N.C.
        Decision aid for trapeziometacarpal arthritis: a randomized controlled trial.
        J Hand Surg Am. 2019; 44 (247.e1–e9)
        • Rosemann T.
        • Joos S.
        • Szecsenyi J.
        • Laux G.
        • Wensing M.
        Health service utilization patterns of primary care patients with osteoarthritis.
        BMC Health Serv Res. 2007; 7: 169
        • Newman A.K.
        • Kapoor S.
        • Thorn B.E.
        Health care utilization for chronic pain in low-income settings.
        Pain Med. 2018; 19: 2387-2397
        • Gold H.T.
        • Slover J.D.
        • Joo L.
        • Bosco J.
        • Iorio R.
        • Oh C.
        Association of depression with 90-day hospital readmission after total joint arthroplasty.
        J Arthroplasty. 2016; 31: 2385-2388
        • Ali A.M.
        • Loeffler M.D.
        • Aylin P.
        • Bottle A.
        Factors associated with 30-day readmission after primary total hip arthroplasty: analysis of 514 455 procedures in the UK National Health Service.
        JAMA Surg. 2017; 152e173949
        • Parrish R.C.
        • Menendez M.E.
        • Mudgal C.S.
        • Jupiter J.B.
        • Chen N.C.
        • Ring D.
        Patient satisfaction and its relation to perceived visit duration with a hand surgeon.
        J Hand Surg Am. 2016; 41: 257-262.e4
        • Jonsdottir T.
        • Jonsdottir H.
        • Lindal E.
        • Oskarsson G.K.
        • Gunnarsdottir S.
        Predictors for chronic pain-related health care utilization: a cross-sectional nationwide study in Iceland.
        Health Expect. 2015; 18: 2704-2719
        • Stockbridge E.L.
        • Suzuki S.
        • Pagan J.A.
        Chronic pain and health care spending: an analysis of longitudinal data from the Medical Expenditure Panel Survey.
        Health Serv Res. 2015; 50: 847-870
        • Wegener S.T.
        • Castillo R.C.
        • Haythornthwaite J.
        • Mackenzie E.J.
        • Bosse M.J.
        Psychological distress mediates the effect of pain on function.
        Pain. 2011; 152: 1349-1357
        • Farzad M.
        • Asgari A.
        • Dashab F.
        • et al.
        Does disability correlate with impairment after hand injury?.
        Clin Orthop Relat Res. 2015; 473: 3470-3476
        • Shin Y.H.
        • Yoon J.O.
        • Kim Y.K.
        • Kim J.K.
        Psychological status is associated with symptom severity in patients with carpal tunnel syndrome.
        J Hand Surg Am. 2018; 43 (484.e1–e8)