Role of Depression in Outcomes of Low-Energy Distal Radius Fractures in Patients Older Than 55 Years.
OBJECTIVE
This study examines depression and outcomes in patients older than 55 years with distal radius fracture.


METHODS
Prospective data collection included patient characteristics, treatment, general and limb symptoms and disability, and complications at baseline, 3 months, and 1 year. Bivariate analysis and multivariable linear regression were used to assess relationships between depression and outcome measures, specifically the Short Form-36 (SF-36), Disability of the Arm, Shoulder, and Hand (DASH) scores, and the Centre of Epidemiologic Studies Depression (CES-D) scale.


METHODS
The study was conducted in a level-1 trauma center.


METHODS
All patients older than 55 years with isolated distal radius fracture were recruited (2007-2011).


METHODS
Patients were treated operatively or nonoperatively.


METHODS
The SF-36 and DASH scores measured general and upper extremity status. Depression was measured using CES-D scale. All complications were recorded.


RESULTS
Of 228 patients, 25% were depressed at baseline, 32% at 3 months, and 26% after 1 year. Thirty-two patients (14%) had complications. There was no relationship between depression at baseline and complications; however, there was a statistically significant relationship at 3 months (P = 0.021). There was a statistically significant association between baseline depression and the worse 1-year SF-36. Patients with baseline depression had poorer 1-year DASH scores (20 ± 2.3) than nondepressed patients (11 ± 1.3) (P = 0.0031), and less improvement in DASH scores over the first year (P = 0.023). Multivariable linear regression demonstrated that baseline depression is the strongest predictor of poorer 1-year DASH scores (3.7, P = 0.0078) and change in DASH scores over the first year (2.9, P = 0.026).


CONCLUSIONS
Baseline depression predicts worse function and disability outcomes 1 year from injury. Depression (CES-D ≥16) is the strongest predictor of worse 1-year DASH scores and SF-36 outcome measures, after controlling for other potential predictors.


METHODS
Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.
The Division of Orthopaedic Trauma, Department of Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
Jane C
JC
Yeoh
Jeffrey M
JM
Pike
Gerard P
GP
Slobogean
Peter J
PJ
OʼBrien
Henry M
HM
Broekhuyse
Kelly A
KA
Lefaivre
D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology*; D011885:Radius Fractures / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome