title: Orthopaedic trauma patients and depression: a prospective cohort.
abstract: OBJECTIVE
  This study prospectively followed a cohort of orthopaedic trauma patients to identify risk factors that contribute to depression in patients with skeletal injuries.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Level I trauma center.
  
  
  METHODS
  One hundred ten orthopaedic trauma patients admitted as inpatients.
  
  
  METHODS
  None.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  METHODS
  Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *Department of Orthopaedics and Rehabilitation, University of New Mexico, Albuquerque, NM; †Department of Primary Care, Atlanta Medical Center, Atlanta, GA; and ‡Department of Orthopaedics, Gwinnett Medical Center, Lawrenceville, GA.
authors.forename: Stephen
authors.initials: S
authors.lastname: Becher
authors.forename: Michele
authors.initials: M
authors.lastname: Smith
authors.forename: Bruce
authors.initials: B
authors.lastname: Ziran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003866:Depressive Disorder / Q000150:complications*; D005260:Female; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009141:Musculoskeletal System / Q000293:injuries*; D011446:Prospective Studies; D012307:Risk Factors; D014193:Trauma Centers; D014947:Wounds and Injuries / Q000150:complications / Q000523:psychology* / Q000628:therapy; D055815:Young Adult