Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32608.
Departments of Orthopaedics and Rehabilitation, University of Florida, Gainesville, FL 32608; Departments of Anesthesia, University of Florida, Gainesville, FL 32608.
Injury. 2020 Jul;51(7):1543-1547. doi: 10.1016/j.injury.2020.04.051. Epub 2020 May 12.
This study evaluates the associations between post injury depressive symptomology and opioid use from the initial time of injury in orthopedic trauma patients without pre-existing psychiatric conditions.
This is a prospective study following the development of symptoms after orthopedic trauma injury conducted at a Level-1 trauma center.
Orthopedic trauma patients (N=96; 43.4±16.5 yrs, 40.6% women) MAIN OUTCOME MEASURES AND ANALYSIS METHODS: Beck Depression Inventory (BDI-II) was administered during index hospitalization and at 2-weeks, 6-weeks, and 3- months, and 6-months. In-hospital and out-patient opioid use were tracked. Regression analyses determined the relationship of opioid use and depressive symptoms during follow-up.
Twenty percent of patients had moderate depressive symptom levels (BDI 20-28 points) and 11% had severe depressive symptom levels (BDI ≥29) at the time of their index hospitalization. Inpatient BDI-II depressive symptom severity levels were significantly related to depressive symptomology at 2 -weeks, 6 -weeks, and 3 -months. In-hospital or discharge opioid dose was not associated with initial or persistent depressive symptomology. Patients with persistent opioid use at 6 weeks had higher depressive symptoms six months following post-discharge than those who ceased opioid use by 6 -weeks post-discharge.
This study suggests that depressive symptomology immediately following musculoskeletal trauma is predictive for persistent depressive symptomology in a subset of our patient population. Inpatient BDI-II depressive symptom severity levels in the hospital were significantly related to BDI-II at 2-weeks, 6-weeks, and 3-months, and persistent opioid use, past 6-weeks, was independently associated with prolonged depressive symptomology as well. Further study into effective treatment and monitoring of mental health disturbances following trauma is needed, particularly in patients with continued need for and use of opioids after discharge.
本研究评估了骨科创伤患者在没有先前精神疾病的情况下，从受伤初始时间起，受伤后抑郁症状与阿片类药物使用之间的关系。
这是一项在一级创伤中心进行的前瞻性研究，跟踪了骨科创伤后症状的发展。
骨科创伤患者（N=96；43.4±16.5 岁，40.6%为女性）
贝克抑郁量表（BDI-II）在住院期间和 2 周、6 周、3 个月和 6 个月时进行评估。跟踪记录住院和门诊阿片类药物的使用情况。回归分析确定了随访期间阿片类药物使用与抑郁症状之间的关系。
20%的患者在指数住院时存在中度抑郁症状水平（BDI 20-28 分），11%的患者存在重度抑郁症状水平（BDI≥29）。住院期间 BDI-II 抑郁症状严重程度与 2 周、6 周和 3 个月时的抑郁症状明显相关。住院或出院时的阿片类药物剂量与初始或持续的抑郁症状无关。在 6 周时持续使用阿片类药物的患者在出院后 6 个月时的抑郁症状较在 6 周时停止使用阿片类药物的患者更高。
本研究表明，肌肉骨骼创伤后立即出现的抑郁症状是我们患者群体中一部分人持续抑郁症状的预测因素。住院期间 BDI-II 的抑郁症状严重程度与 2 周、6 周和 3 个月时的 BDI-II 显著相关，6 周后持续使用阿片类药物与延长的抑郁症状也独立相关。需要进一步研究创伤后有效治疗和监测精神健康障碍，特别是在出院后仍需要和使用阿片类药物的患者中。
