title: Trajectories of depressive symptoms after hip fracture.
abstract: BACKGROUND
  Hip fracture is often complicated by depressive symptoms in older adults. We sought to characterize trajectories of depressive symptoms arising after hip fracture and examine their relationship with functional outcomes and walking ability. We also investigated clinical and psychosocial predictors of these trajectories.
  
  
  METHODS
  We enrolled 482 inpatients, aged ⩾60 years, who were admitted for hip fracture repair at eight St Louis, MO area hospitals between 2008 and 2012. Participants with current depression diagnosis and/or notable cognitive impairment were excluded. Depressive symptoms and functional recovery were assessed with the Montgomery-Asberg Depression Rating Scale and Functional Recovery Score, respectively, for 52 weeks after fracture. Health, cognitive, and psychosocial variables were gathered at baseline. We modeled depressive symptoms using group-based trajectory analysis and subsequently identified correlates of trajectory group membership.
  
  
  RESULTS
  Three trajectories emerged according to the course of depressive symptoms, which we termed 'resilient', 'distressed', and 'depressed'. The depressed trajectory (10% of participants) experienced a persistently high level of depressive symptoms and a slower time to recover mobility than the other trajectory groups. Stressful life events prior to the fracture, current smoking, higher anxiety, less social support, antidepressant use, past depression, and type of implant predicted membership of the depressed trajectory.
  
  
  CONCLUSIONS
  Depressive symptoms arising after hip fracture are associated with poorer functional status. Clinical and psychosocial variables predicted membership of the depression trajectory. Early identification and intervention of patients in a depressive trajectory may improve functional outcomes after hip fracture.
authors.affiliation: Department of Psychiatry,Healthy Mind Lab,Washington University School of Medicine,St Louis,MO,USA.
authors.forename: P
authors.initials: P
authors.lastname: Cristancho
authors.affiliation: Department of Psychiatry,Healthy Mind Lab,Washington University School of Medicine,St Louis,MO,USA.
authors.forename: E J
authors.initials: EJ
authors.lastname: Lenze
authors.affiliation: Department of Anesthesiology,Washington University School of Medicine,St Louis,MO,USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Avidan
authors.affiliation: Department of Psychiatry,Healthy Mind Lab,Washington University School of Medicine,St Louis,MO,USA.
authors.forename: K S
authors.initials: KS
authors.lastname: Rawson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000150:complications* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D051346:Mobility Limitation; D020127:Recovery of Function / Q000502:physiology*; D055500:Resilience, Psychological
keywords: Depression; functional recovery; hip fracture; mobility; older adults; trajectory