title: Prevalence of Depression and Posttraumatic Stress Disorder After Acute Orthopaedic Trauma: A Systematic Review and Meta-Analysis.
abstract: OBJECTIVE
  This study aims to systematically assess the existing literature and to derive a pooled estimate of the prevalence of depression and posttraumatic stress disorder (PTSD) in adult patients after acute orthopaedic trauma.
  
  
  METHODS
  A comprehensive search of databases, including MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled Trials databases was conducted through June 2015.
  
  
  METHODS
  We included studies that assessed the prevalence of depression or PTSD in patients who experienced acute orthopaedic trauma to the appendicular skeleton or pelvis. Studies with a sample size of ≤10 were excluded.
  
  
  METHODS
  Two authors independently extracted data from the selected studies and the data collected were compared with verify agreement.
  
  
  RESULTS
  Twenty-seven studies and 7109 subjects were included in the analysis. Using a random-effects model, the weighted pooled prevalence of depression was 32.6% (95% CI, 25.0%-41.2%) and the weighted pooled prevalence of PTSD was 26.6% (95% CI, 19.0%-35.9%). Six studies evaluated the prevalence of both depression and PTSD in patients with acute orthopaedic injuries. The weighted pooled prevalence of both depression and PTSD for those patients was 16.8% (95% CI, 9.0%-29.4%).
  
  
  CONCLUSIONS
  Nearly one-third of patients suffer from depression and more than one-quarter of patients suffer from PTSD after an acute orthopaedic injury suggesting that strategies to address both the mental and physical rehabilitation after an orthopaedic injury should be considered to optimize patient recovery.
  
  
  METHODS
  Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
authors.affiliation: *University of Maryland School of Medicine, Baltimore, MD; †Graduate Entry Medicine: Royal College of Surgeons in Ireland, Dublin, Ireland; Departments of ‡Orthopaedics, and §Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD; ‖Division of Orthopaedic Surgery, Department of Surgery, McMaster University, ON, Canada; and ¶Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Stefano
authors.initials: S
authors.lastname: Muscatelli
authors.forename: Hayley
authors.initials: H
authors.lastname: Spurr
authors.forename: Nathan N
authors.initials: NN
authors.lastname: OʼHara
authors.forename: Lyndsay M
authors.initials: LM
authors.lastname: OʼHara
authors.forename: Sheila A
authors.initials: SA
authors.lastname: Sprague
authors.forename: Gerard P
authors.initials: GP
authors.lastname: Slobogean
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015984:Causality; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology* / Q000523:psychology*; D055815:Young Adult