Onset of depression in elderly persons after hip fracture: implications for prevention and early intervention of late-life depression.
OBJECTIVE
To identify predictors of onset of major depressive disorder (MDD) and of depressive symptoms in subjects who suffered a hip fracture.


METHODS
Prospective naturalistic study.


METHODS
University of Pittsburgh Medical Center-Shadyside, a large urban hospital in Pittsburgh, Pennsylvannia.


METHODS
One hundred twenty-six elderly patients who received surgical fixation for hip fracture and who were not experiencing a major depressive episode at the time of the fracture; severely cognitively impaired persons were excluded.


METHODS
Subjects were evaluated at the time of hospital discharge using a battery of clinical measures (including apathy measured using the Apathy Evaluation Scale (AES), delirium, cognitive measures, social support, and disability level). Depression was assessed at the end of the surgical stay, 2 weeks later, and then monthly for 6 months, using the Hamilton Rating Scale for Depression (Ham-D) to evaluate symptomatology and the Primary Care Evaluation of Mental Disorders to evaluate diagnosis of MDD.


RESULTS
Eighteen of 126 subjects (14.3%) developed MDD after hip fracture. Of these, 11 developed MDD by the end of the hospitalization, and seven developed MDD between 2 and 10 weeks later. Logistic regression showed that baseline apathy score, as measured using the AES, was the only clinical measure associated with the development of MDD (odds ratio=1.09, 95% confidence interval=1.03-1.16, P=.003); 46.2% of those with high AES scores developed MDD, versus 10.9% of those with lower scores. In contrast, cognitive variables, delirium, disability after hip fracture, and other factors related to the fracture (e.g., fracture type) were not associated with MDD. A repeated-measures analysis with Ham-D over time as a dependent variable generally confirmed these findings; depressive symptoms were highest immediately after the fracture, and apathy and delirium scores were associated with higher depressive symptom levels.


CONCLUSIONS
The onset of MDD is common after hip fracture, and the greatest period of risk is immediately after the fracture. Individuals with clinical evidence of apathy are at high risk for developing MDD, and evaluation and close follow-up of such individuals is warranted. However, further research is needed to examine other candidate variables (e.g., clinical measures or biomarkers) to model adequately the risk for MDD after hip fracture and other disabling medical events.
Lenze
Eric J
EJ
Advanced Center for Interventions and Services Research and John A Hartford Center of Excellence in Geriatric Psychiatry, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA. lenzeej@upmc.edu
Munin
Michael C
MC
Skidmore
Elizabeth R
ER
Dew
Mary Amanda
MA
Rogers
Joan C
JC
Whyte
Ellen M
EM
Quear
Tanya
T
Begley
Amy
A
Reynolds
Charles F
CF
D000339:Affect; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003866:Depressive Disorder / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006620:Hip Fractures / Q000523:psychology* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012372:ROC Curve; D013997:Time Factors
D000928:Antidepressive Agents