Predictors of incident depression after hip fracture surgery.
OBJECTIVE
Depression after hip fracture surgery is prevalent and associated with increased mortality rates and impaired functional recovery. The incidence of new-onset depressive symptoms in patients initially not depressed after hip fracture surgery and their relationship with functional recovery is unknown.


METHODS
A cohort of 139 nondepressed elderly patients (>60 years) hospitalized for hip fracture surgery were followed up for six months. Clinically significant depressive symptoms were defined as a score of 7 or more on the 15-item Geriatric Depression Scale.


RESULTS
The authors found a cumulative incidence rate of 20.5% adjusted for dropouts. Multiple Cox-regression analyses yielded the presence of subthreshold symptoms of depression, anxiety, pain, and cognitive impairment at baseline, the premorbid level of mobility, and a history of (treated) depression as risk factors for incident depression (p <0.05). A forward, conditional procedure identified postoperative pain (hazard ratio [HR] = 1.32, 95% confidence interval [CI]: 1.14-1.53, Wald chi(2) = 13.57, df = 1, p <0.001) and baseline anxiety (HR = 1.25, 95% CI: 1.08-1.44, Wald chi(2) = 8.86, df = 1, p = 0.003) as the strongest independent risk factors. Incident depression was associated with a less favorable outcome at 3 months follow-up.


CONCLUSIONS
This exploratory study identified two treatable baseline characteristics that predicted incident depression in nondepressed patients after hip-fracture surgery.
Voshaar
Richard C Oude
RC
Department of Psychiatry, Nijmegen Medical Centre, Radboud University, Nijmegen, the Netherlands.
Banerjee
Sube
S
Horan
Mike
M
Baldwin
Robert
R
Pendleton
Neil
N
Proctor
Rebekah
R
Tarrier
Nick
N
Woodward
Yvonne
Y
Burns
Alistair
A
D000203:Activities of Daily Living / Q000523:psychology; D000275:Adjustment Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D000368:Aged; D000369:Aged, 80 and over; D015928:Cognitive Behavioral Therapy; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D004739:England; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000453:epidemiology / Q000523:psychology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000523:psychology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors