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The Association Between Depression and Antidepressant Use and Outcomes After Operative Treatment of Distal Radius Fractures at 1 Year

Published:October 29, 2022DOI:https://doi.org/10.1016/j.jhsa.2022.08.018

      Purpose

      Depression has been linked to inferior clinical outcomes among upper extremity patients. It often is challenging to distinguish the symptoms of depression, symptoms of injury, and the interaction between these 2 entities after a patient has been injured. We aimed to study the differences in clinical outcomes after surgical fixation of distal radius fractures between patients with and without a documented history and treatment for depression.

      Methods

      All subjects with an isolated, acute distal radius fracture undergoing operative fixation in a 10-year period at a level 1 academic trauma center were screened. Baseline demographic data were collected, and psychiatric history and antidepressant use were recorded and verified with a pharmacy database. Quick Disability of the Arm, Shoulder and Hand (QuickDASH), range of motion, and grip strength were assessed at 12 months after surgery. Multivariable linear regression analysis was used to assess the association of depression with QuickDASH scores at 1 year after surgery.

      Results

      A total of 211 patients were available for 1-year follow-up, 50 of whom were being treated actively for depression with medication at the time of injury and 161 were without a known diagnosis of, or treatment for, depression. Demographic and injury characteristics were similar between both groups. In a multivariable linear regression model controlling for age, sex, and a history of osteoporosis, active treatment for depression was associated with a slight mean increase in QuickDASH scores, 6.5 (1.3–11.8), 1 year after surgery.

      Conclusions

      This study demonstrates a small increase in QuickDASH scores between subjects with a confirmed diagnoses of depression compared with all others after surgical fixation of distal radius fracture at 1-year follow-up. We suggest that a history of depression may portend worse clinical outcomes, although other factors, such as underreporting of depression may influence results.

      Type of study/level of evidence

      Prognostic IV.

      Key words

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      References

        • National Institute of Mental Health
        Major depression. Bethesda, MD: National Institute of Mental Health. Updated February 2019.
        • Association A.P.
        Diagnostic and statistical manual of mental disorders.
        2013 (Washington, DC)
        • Olfson M.
        • Blanco C.
        • Marcus S.C.
        Treatment of adult depression in the United States.
        JAMA Intern Med. 2016; 176: 1482-1491
        • Vilagut G.
        • Forero C.G.
        • Barbaglia G.
        • Alonso J.
        Screening for depression in the general population with the Center for Epidemiologic Studies Depression (CES-D): a systematic review with meta-analysis.
        PLoS One. 2016; 11e0155431
        • Siddaway A.P.
        • Wood A.M.
        • Taylor P.J.
        The Center for Epidemiologic Studies-Depression (CES-D) scale measures a continuum from well-being to depression: testing two key predictions of positive clinical psychology.
        J Affect Disord. 2017; 213: 180-186
        • Levis B.
        • Benedetti A.
        • Thombs B.D.
        Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis.
        BMJ. 2019; 365: l1476
        • Carleton R.N.
        • Thibodeau M.A.
        • Teale M.J.
        • et al.
        The center for epidemiologic studies depression scale: a review with a theoretical and empirical examination of item content and factor structure.
        PLoS One. 2013; 8e58067
        • Vranceanu A.M.
        • Bachoura A.
        • Weening A.
        • Vrahas M.
        • Smith R.M.
        • Ring D.
        Psychological factors predict disability and pain intensity after skeletal trauma.
        J Bone Joint Surg Am. 2014; 96e20
        • Haupt E.
        • Vincent H.K.
        • Harris A.
        • et al.
        Pre-injury depression and anxiety in patients with orthopedic trauma and their treatment.
        Injury. 2018; 49: 1079-1084
        • Nota S.P.
        • Bot A.G.
        • Ring D.
        • Kloen P.
        Disability and depression after orthopaedic trauma.
        Injury. 2015; 46: 207-212
        • Williams A.E.
        • Newman J.T.
        • Ozer K.
        • Juarros A.
        • Morgan S.J.
        • Smith W.R.
        Posttraumatic stress disorder and depression negatively impact general health status after hand injury.
        J Hand Surg Am. 2009; 34: 515-522
        • Castillo R.C.
        • Carlini A.R.
        • Doukas W.C.
        • et al.
        Pain, depression, and posttraumatic stress disorder following major extremity trauma among United States military serving in Iraq and Afghanistan: results from the military extremity trauma and amputation/limb salvage study.
        J Orthop Trauma. 2021; 35: e96-e102
        • Weekes D.G.
        • Campbell R.E.
        • Shi W.J.
        • et al.
        Prevalence of clinical depression among patients after shoulder stabilization: a prospective study.
        J Bone Joint Surg Am. 2019; 101: 1628-1635
        • Garcia G.H.
        • Wu H.H.
        • Park M.J.
        • et al.
        Depression symptomatology and anterior cruciate ligament injury: incidence and effect on functional outcome--a prospective cohort study.
        Am J Sports Med. 2016; 44: 572-579
        • Ring D.
        • Kadzielski J.
        • Fabian L.
        • Zurakowski D.
        • Malhotra L.R.
        • Jupiter J.B.
        Self-reported upper extremity health status correlates with depression.
        J Bone Joint Surg Am. 2006; 88: 1983-1988
        • Niekel M.C.
        • Lindenhovius A.L.
        • Watson J.B.
        • Vranceanu A.M.
        • Ring D.
        Correlation of DASH and QuickDASH with measures of psychological distress.
        J Hand Surg Am. 2009; 34: 1499-1505
        • Golkari S.
        • Teunis T.
        • Ring D.
        • Vranceanu A.M.
        Changes in depression, health anxiety, and pain catastrophizing between enrollment and 1 month after a radius fracture.
        Psychosomatics. 2015; 56: 652-657
        • Bot A.G.
        • Bekkers S.
        • Herndon J.H.
        • Mudgal C.S.
        • Jupiter J.B.
        • Ring D.
        Determinants of disability after proximal interphalangeal joint sprain or dislocation.
        Psychosomatics. 2014; 55: 595-601
        • Vranceanu A.M.
        • Jupiter J.B.
        • Mudgal C.S.
        • Ring D.
        Predictors of pain intensity and disability after minor hand surgery.
        J Hand Surg Am. 2010; 35: 956-960
        • Dogu B.
        • Kuran B.
        • Sirzai H.
        • Sag S.
        • Akkaya N.
        • Sahin F.
        The relationship between hand function, depression, and the psychological impact of trauma in patients with traumatic hand injury.
        Int J Rehabil Res. 2014; 37: 105-109
        • Gong H.S.
        • Lee J.O.
        • Huh J.K.
        • Oh J.H.
        • Kim S.H.
        • Baek G.H.
        Comparison of depressive symptoms during the early recovery period in patients with a distal radius fracture treated by volar plating and cast immobilisation.
        Injury. 2011; 42: 1266-1270
        • Jayakumar P.
        • Overbeek C.L.
        • Lamb S.
        • et al.
        What factors are associated with disability after upper extremity injuries? A systematic review.
        Clin Orthop Relat Res. 2018; 476: 2190-2215
        • Nellans K.W.
        • Kowalski E.
        • Chung K.C.
        The epidemiology of distal radius fractures.
        Hand Clin. 2012; 28: 113-125
        • Roh Y.H.
        • Lee B.K.
        • Noh J.H.
        • Oh J.H.
        • Gong H.S.
        • Baek G.H.
        Effect of anxiety and catastrophic pain ideation on early recovery after surgery for distal radius fractures.
        J Hand Surg Am. 2014; 39: 2258-2264.e2
        • 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
        • Fitzpatrick S.K.
        • Casemyr N.E.
        • Zurakowski D.
        • Day C.S.
        • Rozental T.D.
        The effect of osteoporosis on outcomes of operatively treated distal radius fractures.
        J Hand Surg Am. 2012; 37: 2027-2034
        • Ostergaard P.J.
        • Hall M.J.
        • Rozental T.D.
        Considerations in the treatment of osteoporotic distal radius fractures in elderly patients.
        Curr Rev Musculoskelet Med. 2019; 12: 50-56
        • Institute for Work & Health
        The DASH outcome measure. 2012.
        (Accessed March 7, 2022.)
        • Kim H.Y.
        Statistical notes for clinical researchers: chi-squared test and Fisher's exact test.
        Restor Dent Endod. 2017; 42: 152-155
        • Franchignoni F.
        • Vercelli S.
        • Giordano A.
        • Sartorio F.
        • Bravini E.
        • Ferriero G.
        Minimal clinically important difference of the disabilities of the arm, shoulder and hand outcome measure (DASH) and its shortened version (QuickDASH).
        J Orthop Sports Phys Ther. 2014; 44: 30-39
        • Sorensen A.A.
        • Howard D.
        • Tan W.H.
        • Ketchersid J.
        • Calfee R.P.
        Minimal clinically important differences of 3 patient-rated outcomes instruments.
        J Hand Surg Am. 2013; 38: 641-649
        • Pilkonis P.A.
        • Yu L.
        • Dodds N.E.
        • Johnston K.L.
        • Maihoefer C.C.
        • Lawrence S.M.
        Validation of the depression item bank from the Patient-Reported Outcomes Measurement Information System (PROMIS) in a three-month observational study.
        J Psychiatr Res. 2014; 56: 112-119
        • Anderson N.P.
        • Feldman J.A.
        • Kolko D.J.
        • Pilkonis P.A.
        • Lindhiem O.
        National norms for the Vanderbilt ADHD Diagnostic Parent Rating Scale in children.
        J Pediatr Psychol. 2022; 47: 652-661
        • Hampton S.N.
        • Nakonezny P.A.
        • Richard H.M.
        • Wells J.E.
        Pain catastrophizing, anxiety, and depression in hip pathology.
        Bone Joint J. 2019; 101-b: 800-807
        • Ajibola G.
        • Zash R.
        • Shapiro R.L.
        • et al.
        Detecting congenital malformations - lessons learned from the Mpepu study, Botswana.
        PLoS One. 2017; 12e0173800
        • Cochrane S.
        • Dale A.M.
        • Buckner-Petty S.
        • Sobel A.D.
        • Lippold B.
        • Calfee R.P.
        Relevance of diagnosed depression and antidepressants to promis depression scores among hand surgical patients.
        J Hand Surg Am. 2021; 46: 99-105
        • Mojtabai R.
        • Olfson M.
        National trends in long-term use of antidepressant medications: results from the U.S. National Health and Nutrition Examination Survey.
        J Clin Psychiatry. 2014; 75: 169-177