Lippold Brandon, Tarkunde Yash R, Cheng Abby L, Hannon Charles P, Adelani Muyibat A, Calfee Ryan P
Department of Orthopedic Surgery, School of Medicine, Washington University in St. Louis, St. Louis, MO, USA.
Arthroplast Today. 2022 Mar 2;15:215-219.e1. doi: 10.1016/j.artd.2022.01.032. eCollection 2022 Jun.
This study investigated the utility of depression and anxiety symptom screening in patients scheduled for total knee arthroplasty to examine differences in active symptoms according to patients' mental health diagnoses and associated prescription medications.
This cross-sectional study analyzed 594 patients scheduled for total knee arthroplasty at a tertiary practice between June 2018 and December 2018. Patients completed Patient-Reported Outcomes Measurements Information System (PROMIS) Depression and Anxiety Computerized Adaptive Tests in clinic quantifying active symptoms. Mental health diagnoses and associated medications were extracted from health records. Statistical analysis assessed between-group differences in mean PROMIS scores and the prevalence of heightened depressive and anxiety symptoms.
Multivariable linear regression modeling demonstrated that being diagnosed with depression without medication (β 7.1; < .001) and with medication (β 8.6; < .001) were each associated with higher PROMIS Depression scores. Similar modeling demonstrated that patients diagnosed with anxiety and prescribed an anxiolytic (β 8.4; < .001) were associated with higher PROMIS Anxiety scores than undiagnosed patients. Eighty-six (15%) patients experienced heightened anxiety and/or depressive symptoms. Heightened depressive symptoms were more prevalent among those diagnosed with depression (19% without medication, 24% with antidepressant vs 5% undiagnosed: < .001). Heightened anxiety symptoms were most prevalent among those diagnosed with anxiety and on anxiolytic medication (25% vs 7% diagnosed with anxiety without medication, 8% undiagnosed: < .001).
One in seven arthroplasty patients screened reported heightened depressive and/or anxiety symptoms. Despite the majority of arthroplasty patients on antidepressants and anxiolytics having symptoms controlled, these patients remain at increased risk of heightened active symptoms.
本研究调查了全膝关节置换术患者抑郁和焦虑症状筛查的效用，以根据患者的心理健康诊断和相关处方药检查活跃症状的差异。
这项横断面研究分析了2018年6月至2018年12月在一家三级医疗机构计划进行全膝关节置换术的594例患者。患者在诊所完成了患者报告结局测量信息系统（PROMIS）抑郁和焦虑计算机自适应测试，以量化活跃症状。从健康记录中提取心理健康诊断和相关药物。统计分析评估了平均PROMIS评分的组间差异以及抑郁和焦虑症状加重的患病率。
多变量线性回归模型表明，被诊断为未服用药物的抑郁症患者（β 7.1；P <.001）和服用药物的抑郁症患者（β 8.6；P <.001）均与较高的PROMIS抑郁评分相关。类似的模型表明，被诊断为焦虑症并开具抗焦虑药的患者（β 8.4；P <.001）与未被诊断的患者相比，PROMIS焦虑评分更高。86例（15%）患者出现焦虑和/或抑郁症状加重。抑郁症状加重在被诊断为抑郁症的患者中更为普遍（未服用药物的患者中为19%，服用抗抑郁药的患者中为24%，未被诊断的患者中为5%：P <.001）。焦虑症状加重在被诊断为焦虑症并服用抗焦虑药的患者中最为普遍（25%，而被诊断为未服用药物的焦虑症患者中为7%，未被诊断的患者中为8%：P <.001）。
在接受筛查的关节置换术患者中，七分之一的患者报告有抑郁和/或焦虑症状加重。尽管大多数服用抗抑郁药和抗焦虑药的关节置换术患者症状得到控制，但这些患者仍有活跃症状加重的风险增加。
