Background: There is a known connection between physical injury and
disability and emotional distress. Several investigators have shown a
relationship between trauma, depression, and poor outcomes. The literature on
trauma and depression is limited with regard to clarifying the relationship
between the degree of injury and depression and the relationship between
physical function of patients with less severe injuries and depression.
Methods: One hundred and sixty-one patients who presented to our
orthopaedic trauma services were enrolled in the study and interviewed. We
obtained information about patient demographics and administered several
self-reported outcome measures: the Beck Depression Inventory (BDI), the Short
Musculoskeletal Function Assessment (SMFA), and the Physical Function-10
(PF-10) subset of the Short Form-36 (SF-36). We documented the nature and
severity of the injury or injuries and calculated correlations between the
outcome measures and the BDI. Injury-specific factors such as the AO Fracture
Classification, the Abbreviated Injury Scale (AIS), the Injury Severity Score
(ISS), and the Gustilo and Anderson grade of open fractures were also
Results: Fifty-five percent of the patients had minimal depression,
as measured with the BDI; 28% had moderate depression; 13% had
moderate-to-severe depression; and 3.7% had severe depression. When the
somatic elements of the BDI were removed, the prevalence of moderate,
moderate-to-severe, or severe depression was 26%. The SMFA scores had a strong
negative correlation with the BDI (—0.75; p < 0.001). Of the
injury-specific factors, only open factures were found to have an impact on
the presence of depression, with an odds ratio of 4.58 (95% confidence ratio,
1.57 to 12.35).
Conclusions: The prevalence of clinically relevant depression
approached 45% in a diverse cohort of orthopaedic trauma patients. Global
disability is strongly correlated with depression. The presence of an open
fracture may also increase the risk of depression.
Level of Evidence: Prognostic Level II. See Instructions
to Authors for a complete description of levels of evidence.