Voshaar Richard C Oude, Banerjee Sube, Horan Mike, Baldwin Robert, Pendleton Neil, Proctor Rebekah, Tarrier Nick, Woodward Yvonne, Burns Alistair
Department of Psychiatry, Nijmegen Medical Centre, Radboud University, Nijmegen, the Netherlands.
Am J Geriatr Psychiatry. 2007 Sep;15(9):807-14. doi: 10.1097/JGP.0b013e318098610c. Epub 2007 Aug 13.
Depression after hip fracture surgery is prevalent and associated with increased mortality rates and impaired functional recovery. The incidence of new-onset depressive symptoms in patients initially not depressed after hip fracture surgery and their relationship with functional recovery is unknown.
A cohort of 139 nondepressed elderly patients (>60 years) hospitalized for hip fracture surgery were followed up for six months. Clinically significant depressive symptoms were defined as a score of 7 or more on the 15-item Geriatric Depression Scale.
The authors found a cumulative incidence rate of 20.5% adjusted for dropouts. Multiple Cox-regression analyses yielded the presence of subthreshold symptoms of depression, anxiety, pain, and cognitive impairment at baseline, the premorbid level of mobility, and a history of (treated) depression as risk factors for incident depression (p <0.05). A forward, conditional procedure identified postoperative pain (hazard ratio [HR] = 1.32, 95% confidence interval [CI]: 1.14-1.53, Wald chi(2) = 13.57, df = 1, p <0.001) and baseline anxiety (HR = 1.25, 95% CI: 1.08-1.44, Wald chi(2) = 8.86, df = 1, p = 0.003) as the strongest independent risk factors. Incident depression was associated with a less favorable outcome at 3 months follow-up.
This exploratory study identified two treatable baseline characteristics that predicted incident depression in nondepressed patients after hip-fracture surgery.
髋部骨折手术后抑郁症很常见，且与死亡率增加和功能恢复受损有关。髋部骨折手术后最初无抑郁症状的患者中新发抑郁症状的发生率及其与功能恢复的关系尚不清楚。
对139名因髋部骨折手术住院的非抑郁老年患者（>60岁）进行了为期6个月的随访。临床上显著的抑郁症状定义为15项老年抑郁量表得分7分或更高。
作者发现经失访调整后的累积发病率为20.5%。多项Cox回归分析得出，基线时存在抑郁、焦虑、疼痛和认知障碍的阈下症状、病前活动水平以及（接受过治疗的）抑郁病史是新发抑郁的危险因素（p<0.05）。一种向前条件程序确定术后疼痛（风险比[HR]=1.32，95%置信区间[CI]：1.14-1.53，Wald卡方(2)=13.57，自由度=1，p<0.001）和基线焦虑（HR=1.25，95%CI：1.08-1.44，Wald卡方(2)=8.86，自由度=1，p=0.003）是最强的独立危险因素。新发抑郁与3个月随访时较差的预后相关。
这项探索性研究确定了两个可治疗的基线特征，它们可预测髋部骨折手术后非抑郁患者的新发抑郁。
