Hostname: page-component-cd9895bd7-dk4vv Total loading time: 0 Render date: 2024-12-26T21:42:30.479Z Has data issue: false hasContentIssue false
  • English
  • Français

Trajectories of depressive symptoms after hip fracture

Published online by Cambridge University Press:  05 February 2016

P. Cristancho ,
E. J. Lenze ,
M. S. Avidan  and
K. S. Rawson
P. Cristancho*
Affiliation:
Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St Louis, MO, USA
E. J. Lenze
Affiliation:
Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St Louis, MO, USA
M. S. Avidan
Affiliation:
Department of Anesthesiology, Washington University School of Medicine, St Louis, MO, USA
K. S. Rawson
Affiliation:
Department of Psychiatry, Healthy Mind Lab, Washington University School of Medicine, St Louis, MO, USA
*
*Address for correspondence: P. Cristancho, MD, Department of Psychiatry, Healthy Mind Lab, School of Medicine, Washington University School of Medicine, Campus Box 8134, 660 South Euclid, St Louis, MO 63110, USA. (Email: cristanp@psychiatry.wustl.edu)
Get access Rights & Permissions [Opens in a new window]

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.

Method

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.

Keywords

Depressionfunctional recoveryhip fracturemobilityolder adultstrajectory
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 7 , May 2016 , pp. 1413 - 1425
Copyright
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Álamo, C, López-Muñoz, F, García-García, P, García-Ramos, S (2014). Risk–benefit analysis of antidepressant drug treatment in the elderly. Psychogeriatrics 14, 261–268.Google Scholar
Beaupre, LA, Binder, EF, Cameron, ID, Jones, CA, Orwig, D, Sherrington, C, Magaziner, J (2013). Maximising functional recovery following hip fracture in frail seniors. Best Practice and Research Clinical Rheumatology 27, 771–788.Google Scholar
Beekman, ATF, Deeg, DJH, Braam, AW, Smit, JH, Van Tilburg, W (1997). Consequences of major and minor depression in later life: a study of disability, well-being and service utilization. Psychological Medicine 27, 1397–1409.Google Scholar
Bentler, SE, Liu, L, Obrizan, M, Cook, EA, Wright, KB, Geweke, JF, Chrischilles, EA, Pavlik, CE, Wallace, RB, Ohsfeldt, RL, Jones, MP, Rosenthal, GE, Wolinsky, FD (2009). The aftermath of hip fracture: discharge placement, functional status change, and mortality. American Journal of Epidemiology 170, 1290–1299.CrossRefGoogle ScholarPubMed
Berg, CZ, Shapiro, N, Chambless, DL, Ahrens, AH (1998). Are emotions frightening? II: an analogue study of fear of emotion, interpersonal conflict, and panic onset1. Behaviour Research and Therapy 36, 3–15.Google Scholar
Bridle, C, Spanjers, K, Patel, S, Atherton, NM, Lamb, SE (2012). Effect of exercise on depression severity in older people: systematic review and meta-analysis of randomised controlled trials. British Journal of Psychiatry 201, 180–185.Google Scholar
Brown, GW, Craig, TKJ, Harris, TO, Herbert, J, Hodgson, K, Tansey, KE, Uher, R (2014). Functional polymorphism in the brain-derived neurotrophic factor gene interacts with stressful life events but not childhood maltreatment in the etiology of depression. Depression and Anxiety 31, 326–334.Google Scholar
Cleeland, C, Ryan, R (1994). Pain assessment: global use of the brief pain inventory. Annals of the Academy of Medicine, Singapore 23, 129–138.Google Scholar
Denkinger, MD, Lukas, A, Nikolaus, T, Peter, R, Franke, S, Group for the A study (2014). Multisite pain, pain frequency and pain severity are associated with depression in older adults: results from the ActiFE Ulm study. Age and Ageing 43, 510–514.CrossRefGoogle ScholarPubMed
Devanand, DP, Kim, MK, Paykina, N, Sackeim, HA (2002). Adverse life events in elderly patients with major depression or dysthymic disorder and in healthy-control subjects. American Journal of Geriatric Psychiatry 10, 265–274.Google Scholar
Diniz, BS, Reynolds, CF (2014). Major depressive disorder in older adults: benefits and hazards of prolonged treatment. Drugs and Aging 31, 661–669.CrossRefGoogle ScholarPubMed
Feinstein, A (1999). Mood and motivation in rehabilitation. In Cognitive Neurorehabilitation (ed. Stuss, D. T., Winocur, G. and Robertson, I. H.), pp. 230–239. Cambridge University Press: New York.Google Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured clinical interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). American Psychiatric Press Inc.: Washington, DC.Google Scholar
George, LK, Blazer, DG, Hughes, DC, Fowler, N (1989). Social support and the outcome of major depression. British Journal of Psychiatry 154, 478–485.Google Scholar
Givens, JL, Sanft, TB, Marcantonio, ER (2008). Functional recovery after hip fracture: the combined effects of depressive symptoms, cognitive impairment, and delirium. Journal of the American Geriatrics Society 56, 1075–1079.Google Scholar
Hannan, EL, Magaziner, J, Wang, JJ, Eastwood, EA, Silberzweig, SB, Gilbert, M, Morrison, RS, McLaughlin, MA, Orosz, GM, Siu, AL (2001). Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes. Journal of the American Medical Association 285, 2736–2742.Google Scholar
Herrmann, N, Black, SE, Lawrence, J, Szekely, C, Szalai, JP (1998). The sunnybrook stroke study a prospective study of depressive symptoms and functional outcome. Stroke 29, 618–624.CrossRefGoogle ScholarPubMed
Hershkovitz, A, Kalandariov, Z, Hermush, V, Weiss, R, Brill, S (2007). Factors affecting short-term rehabilitation outcomes of disabled elderly patients with proximal hip fracture. Archives of Physical Medicine and Rehabilitation 88, 916–921.Google Scholar
Heyes, GJ, Tucker, A, Marley, D, Foster, A (2015). Predictors for 1-year mortality following hip fracture: a retrospective review of 465 consecutive patients. European Journal of Trauma and Emergency Surgery. Published online: 11 August 2015. PMID: 26260068.Google Scholar
Holmes, JD, House, AO (2000 a). Psychiatric illness in hip fracture. Age and Ageing 29, 537–546.Google Scholar
Holmes, J, House, A (2000 b). Psychiatric illness predicts poor outcome after surgery for hip fracture: a prospective cohort study. Psychological Medicine 30, 921–929.Google Scholar
Iaboni, A, Seitz, DP, Fischer, HD, Diong, CC, Rochon, PA, Flint, AJ (2015). Initiation of antidepressant medication after hip fracture in community-dwelling older adults. American Journal of Geriatric Psychiatry 23, 1007–1015.CrossRefGoogle ScholarPubMed
Jackson, WC (2013). Assessing and managing pain and major depression with medical comorbidities. Journal of Clinical Psychiatry 74, e24.Google Scholar
Jensen, MP, Karoly, P (1992). Self-report scales and procedures for assessing pain in adults. In Handbook of Pain Assessment (ed. Turk, D. C., Melzack, R., Turk, D. C. and Melzack, R.), pp. 135–151. Guilford Press: New York, NY, US.Google Scholar
Karp, JF, Scott, J, Houck, P, Reynolds, CF, Kupfer, DJ, Frank, E (2005). Pain predicts longer time to remission during treatment of recurrent depression. Journal of Clinical Psychiatry 66, 591–597.Google Scholar
Katzman, R, Brown, T, Fuld, P, Peck, A, Schechter, R, Schimmel, H (1983). Validation of a short orientation-memory-concentration test of cognitive impairment. American Journal of Psychiatry 140, 734–739.Google Scholar
Kendler, KS, Karkowski, LM, Prescott, CA (1999). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry 156, 837–841.Google Scholar
Kennedy, GJ, Kelman, HR, Thomas, C (1990). The emergence of depressive symptoms in late life: the importance of declining health and increasing disability. Journal of Community Health 15, 93–104.Google Scholar
Kim, S-M, Moon, Y-W, Lim, S-J, Yoon, B-K, Min, Y-K, Lee, D-Y, Park, Y-S (2012). Prediction of survival, second fracture, and functional recovery following the first hip fracture surgery in elderly patients. Bone 50, 1343–1350.CrossRefGoogle ScholarPubMed
Kvelde, T, McVeigh, C, Toson, B, Greenaway, M, Lord, SR, Delbaere, K, Close, JCT (2013). Depressive symptomatology as a risk factor for falls in older people: systematic review and meta-analysis. Journal of the American Geriatrics Society 61, 694–706.Google Scholar
Landerman, R, George, LK, Campbell, RT, Blazer, DG (1989). Alternative models of the stress buffering hypothesis. American Journal of Community Psychology 17, 625–642.Google Scholar
Lenze, EJ, Host, HH, Hildebrand, M, Morrow-Howell, N, Carpenter, B, Freedland, KE, Baum, CM, Binder, EF (2013). Enhanced medical rehabilitation is feasible in a skilled nursing facility: preliminary data on a novel treatment for older adults with depression. American Journal of Geriatric Psychiatry 21, 307.Google Scholar
Lenze, EJ, Munin, MC, Dew, MA, Rogers, JC, Seligman, K, Mulsant, BH, Reynolds, CF (2004). Adverse effects of depression and cognitive impairment on rehabilitation participation and recovery from hip fracture. International Journal of Geriatric Psychiatry 19, 472–478.Google Scholar
Lenze, EJ, Munin, MC, Skidmore, ER, Amanda Dew, M, Rogers, JC, Whyte, EM, Quear, T, Begley, A, Reynolds, CF (2007). Onset of depression in elderly persons after hip fracture: implications for prevention and early intervention of late-life depression. Journal of the American Geriatrics Society 55, 81–86.Google Scholar
Lenze, EJ, Rogers, JC, Martire, LM, Mulsant, BH, Rollman, BL, Dew, MA, Schulz, R, Reynolds, CF III (2001). The association of late-life depression and anxiety with physical disability: a review of the literature and prospectus for future research. American Journal of Geriatric Psychiatry 9, 113–135.Google Scholar
Magaziner, J, Fredman, L, Hawkes, W, Hebel, JR, Zimmerman, S, Orwig, DL, Wehren, L (2003). Changes in functional status attributable to hip fracture: a comparison of hip fracture patients to community-dwelling aged. American Journal of Epidemiology 157, 1023–1031.Google Scholar
Miller, MD, Paradis, CF, Houck, PR, Mazumdar, S, Stack, JA, Rifai, AH, Mulsant, B, Reynolds, CF III (1992). Rating chronic medical illness burden in geropsychiatric practice and research: application of the cumulative illness rating scale. Psychiatry Research 41, 237–248.Google Scholar
Montgomery, SA, Asberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.Google Scholar
Morghen, S, Bellelli, G, Manuele, S, Guerini, F, Frisoni, GB, Trabucchi, M (2011). Moderate to severe depressive symptoms and rehabilitation outcome in older adults with hip fracture. International Journal of Geriatric Psychiatry 26, 1136–1143.Google Scholar
Morone, NE, Weiner, DK, Belnap, BH, Hum, B, Karp, JF, Mazumdar, S, Houck, PR, He, F, Rollman, BL (2010). The impact of pain and depression on post-CABG recovery. Psychosomatic Medicine 72, 620–625.CrossRefGoogle ScholarPubMed
Mossey, JM, Knott, K, Craik, R (1990). The effects of persistent depressive symptoms on hip fracture recovery. Journal of Gerontology 45, M163–M168.Google Scholar
Müller-Thomsen, T, Mittermeier, O, Ganzer, S (2002). Unrecognised and untreated depression in geriatric patients with hip fractures. International Journal of Geriatric Psychiatry 17, 683–684.CrossRefGoogle ScholarPubMed
Nagin, DS, Odgers, CL (2010). Group-based trajectory modeling in clinical research. Annual Review of Clinical Psychology 6, 109–138.Google Scholar
Ormel, J, Rijsdijk, FV, Sullivan, M, van Sonderen, E, Kempen, GIJM (2002). Temporal and reciprocal relationship between iadl/adl disability and depressive symptoms in late life. Journals of Gerontology Series B: Psychological Sciences and Social Sciences 57, P338–P347.Google Scholar
Oude Voshaar, RC, Banerjee, S, Horan, M, Baldwin, R, Pendleton, N, Proctor, R, Tarrier, N, Woodward, Y, Burns, A (2007). Predictors of incident depression after hip fracture surgery. American Journal of Geriatric Psychiatry 15, 807–814.Google Scholar
Parkkari, J, Kannus, P, Palvanen, M, Natri, A, Vainio, J, Aho, H, Vuori, I, Järvinen, M (1999). Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcified Tissue International 65, 183–187.Google Scholar
Penninx, BW, Leveille, S, Ferrucci, L, van Eijk, JT, Guralnik, JM (1999). Exploring the effect of depression on physical disability: longitudinal evidence from the established populations for epidemiologic studies of the elderly. American Journal of Public Health 89, 1346–1352.Google Scholar
Petrovic, NM, Milovanovic, DR, Ignjatovic Ristic, D, Riznic, N, Ristic, B, Stepanovic, Z (2014). Factors associated with severe postoperative pain in patients with total hip arthroplasty. Acta Orthopaedica et Traumatologica Turcica 48, 615–622.CrossRefGoogle ScholarPubMed
Podsiadlo, D, Richardson, S (1991). The timed ‘up & go’: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society 39, 142–148.Google Scholar
Prince, MJ, Harwood, RH, Blizard, RA, Thomas, A, Mann, AH (1997). Impairment, disability and handicap as risk factors for depression in old age: the Gospel Oak project V. Psychological Medicine 27, 311–321.Google Scholar
Rawson, KS, Dixon, D, Nowotny, P, Ricci, WM, Binder, EF, Rodebaugh, TL, Wendleton, L, Doré, P, Lenze, EJ (2015). Association of functional polymorphisms from brain-derived neurotrophic factor and serotonin-related genes with depressive symptoms after a medical stressor in older adults. PLoS ONE 10, e0120685.Google Scholar
Salpakoski, A, Törmäkangas, T, Edgren, J, Sihvonen, S, Pekkonen, M, Heinonen, A, Pesola, M, Kallinen, M, Rantanen, T, Sipilä, S (2014). Walking recovery after a hip fracture: a prospective follow-up study among community-dwelling over 60-year old men and women. BioMed Research International 2014, 289549.Google Scholar
Shyu, Y-IL, Cheng, H-S, Teng, H-C, Chen, M-C, Wu, C-C, Tsai, W-C (2009). Older people with hip fracture: depression in the postoperative first year. Journal of Advanced Nursing 65, 2514–2522.CrossRefGoogle ScholarPubMed
Stubbs, B, Stubbs, J, Gnanaraj, SD, Soundy, A (2016). Falls in older adults with major depressive disorder (MDD): a systematic review and exploratory meta-analysis of prospective studies. International Psychogeriatrics 28, 23–29.Google Scholar
Sutin, AR, Terracciano, A, Milaneschi, Y, An, Y, Ferrucci, L, Zonderman, AB (2013). The trajectory of depressive symptoms across the adult life span. JAMA Psychiatry 70, 803–811.Google Scholar
Swardfager, W, Herrmann, N, Marzolini, S, Saleem, M, Farber, SB, Kiss, A, Oh, PI, Lanctôt, KL (2011). Major depressive disorder predicts completion, adherence, and outcomes in cardiac rehabilitation: a prospective cohort study of 195 patients with coronary artery disease. Journal of Clinical Psychiatry 72, 1181–1188.Google Scholar
Swartz, JR, Williamson, DE, Hariri, AR (2014). Developmental change in amygdala reactivity during adolescence: effects of family history of depression and stressful life events. American Journal of Psychiatry 172, 276–283.Google Scholar
Trzepacz, PT, Dew, MA (1995). Further analyses of the delirium rating scale. General Hospital Psychiatry 17, 75–79.CrossRefGoogle ScholarPubMed
Tseng, M-Y, Shyu, Y-IL, Liang, J (2012). Functional recovery of older hip-fracture patients after interdisciplinary intervention follows three distinct trajectories. Gerontologist 52, 833–842.Google Scholar
Williams, CS, Tinetti, ME, Kasl, SV, Peduzzi, PN (2006). The role of pain in the recovery of instrumental and social functioning after hip fracture. Journal of Aging and Health 18, 743–762.CrossRefGoogle ScholarPubMed
Williamson, GM, Schulz, R (1992). Pain, activity restriction, and symptoms of depression among community-residing elderly adults. Journal of Gerontology 47, P367–P372.Google Scholar
Zeiss, AM, Lewinsohn, PM, Rohde, P, Seeley, JR (1996). Relationship of physical disease and functional impairment to depression in older people. Psychology and Aging 11, 572–581.Google Scholar
Zuckerman, J, Koval, K, Aharonoff, G, Hiebert, R, Skovron, M (2000). A functional recovery score for elderly hip fracture patients: I. development. Journal of Orthopaedic Trauma January 14, 20–25.Google Scholar
Zuckerman, JD (1996). Hip fracture. New England Journal of Medicine 334, 1519–1525.Google Scholar
Supplementary material: File

Cristancho supplementary material

Table S1

Download Cristancho supplementary material(File)
File 19.1 KB