Role of Depression in Outcomes of Low-Energy Distal Radius Fractures in Patients Older Than 55 Years

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Objectives:This study examines depression and outcomes in patients older than 55 years with distal radius fracture.Design:Prospective data collection included patient characteristics, treatment, general and limb symptoms and disability, and complications at baseline, 3 months, and 1 year. Bivariate analysis and multivariable linear regression were used to assess relationships between depression and outcome measures, specifically the Short Form-36 (SF-36), Disability of the Arm, Shoulder, and Hand (DASH) scores, and the Centre of Epidemiologic Studies Depression (CES-D) scale.Setting:The study was conducted in a level-1 trauma center.Participants:All patients older than 55 years with isolated distal radius fracture were recruited (2007–2011).Intervention:Patients were treated operatively or nonoperatively.Main Outcome Measures:The SF-36 and DASH scores measured general and upper extremity status. Depression was measured using CES-D scale. All complications were recorded.Results:Of 228 patients, 25% were depressed at baseline, 32% at 3 months, and 26% after 1 year. Thirty-two patients (14%) had complications. There was no relationship between depression at baseline and complications; however, there was a statistically significant relationship at 3 months (P = 0.021). There was a statistically significant association between baseline depression and the worse 1-year SF-36. Patients with baseline depression had poorer 1-year DASH scores (20 ± 2.3) than nondepressed patients (11 ± 1.3) (P = 0.0031), and less improvement in DASH scores over the first year (P = 0.023). Multivariable linear regression demonstrated that baseline depression is the strongest predictor of poorer 1-year DASH scores (3.7, P = 0.0078) and change in DASH scores over the first year (2.9, P = 0.026).Conclusions:Baseline depression predicts worse function and disability outcomes 1 year from injury. Depression (CES-D ≥16) is the strongest predictor of worse 1-year DASH scores and SF-36 outcome measures, after controlling for other potential predictors.Level of Evidence:Prognostic Level I. See Instructions for Authors for a complete description of levels of evidence.

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