Prevalence of Depression and Posttraumatic Stress Disorder After Acute Orthopaedic Trauma: A Systematic Review and Meta-Analysis

Muscatelli, Stefano; Spurr, Hayley; O’Hara, Nathan N.; O’Hara, Lyndsay M.; Sprague, Sheila; Slobogean, Gerard P.

doi:10.1097/bot.0000000000000664

Cited by 82 publications

(78 citation statements)

References 51 publications

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“…Given methodological differences, it is difficult to directly compare our findings with other studies but the prevalence of anxiety and depression found in this study is slightly less than those reported for facial palsy (Fu et al, 2011) and facial paralysis (Pouwels et al, 2016). The findings suggest that facial scarring may result in a similar burden of depression but lower burden of anxiety than seen in acne patients (Lukaviciute et al, 2017), and a lower burden of depression compared to orthopaedic trauma patients (Muscatelli et al, 2016 (Egede, 2007). Patients with the latter conditions routinely receive more regular contact from health care providers and, therefore, there is greater opportunity to identify developing psychological comorbidity.…”

Section: Biascontrasting

confidence: 75%

The association of affective disorders and facial scarring: Systematic review and meta-analysis

Gibson

Ackling

Bisson

et al. 2018

Journal of Affective Disorders

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Section: Biascontrasting

confidence: 75%

The association of affective disorders and facial scarring: Systematic review and meta-analysis

Gibson

Ackling

Bisson

et al. 2018

Journal of Affective Disorders

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“…While the disparities in research participation have been investigated in multiple clinical areas of research, there is a paucity of data specific to patients with traumatic injuries. Despite the psychological distress associated with a traumatic injury,11 refusal rates for trauma trials may be much lower than what has been reported in oncology literature. Several recently completed trials of orthopaedic trauma patients reported refusal rates of less than 15% 12–14…”

Section: Introductionmentioning

confidence: 76%

Which orthopaedic trauma patients are likely to refuse to participate in a clinical trial? A latent class analysis

O’Hara

Degani

Marvel³

et al. 2019

BMJ Open

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ObjectiveThe study aimed to assess systematic differences in the characteristics of patients that consented for the trial compared with the broader pool of eligible patients in a large, pragmatic orthopaedic trauma trial.DesignA retrospective observational study performed from April 2017 to March 2018.SettingAcademic trauma centre in Baltimore, USA.ParticipantsThere were 642 eligible adult trial participants with an operative fracture to the appendicular skeleton and were indicated for blood clot prophylaxis. The median age of the sample was 50 years (IQR: 31–63), and 60% were male.Primary outcome measureThe primary outcome was the refusal to enrol in the trial. Demographic and injury covariates were included in iterations of latent class models. The final model was selected based on a minimum Bayesian information criterion.ResultsThe final model identified three clusters with five covariates predictive of cluster membership (age, neighbourhood-based socioeconomic status, alcohol use, multiple fractures, multiple surgeries). The three clusters were associated with 22% (Cluster 1), 38% (Cluster 2) and 62% (Cluster 3) refusal rates, respectively. Members of Cluster 3 (n=84) were most commonly between 66 and 80 years of age (49% vs 6% (Cluster 1) and 21% (Cluster 2)), of high neighbourhood-based socioeconomic status (85% vs 63% (Cluster 1) and 8% (Cluster 2)), with isolated fractures (100% vs 80% (Cluster 1) and 92% (Cluster 2)), and were less likely to have multiple surgeries compared with the other clusters (28% vs 47% (Cluster 1) and 35% (Cluster 2)).ConclusionIn this study, the likelihood of refusing to participate in the trial ranged from 22% to 62% in the three identified clusters. Elderly age, high socioeconomic status, and less severe injuries defined the cluster that was most likely to refuse trial participation.Trial registration number NCT02984384.

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“…Interest in PTSD is increasing with a greater recognition of the deleterious effects of trauma and with the number of military personnel with amputations who experienced combat-related trauma (Doukas et al, 2013;Tennent et al, 2014). Critical reviews report higher rates of depression and post-traumatic stress disorder (PTSD) among patients with orthopaedic traumas (pooled estimates of 32.6% and 26.6%, respectively; Muscatelli et al, 2017) and hand trauma (Ladds, Redgrave, Hotton, & Lamyman, 2017) than observed among people in general. Studies have reported rates ranging from 20 to 47% of probable depression (Mckechnie & John, 2014), and 22.9-26% of possible PTSD (over a 6-month period; Phelps et al, 2008) among individuals with limb loss.…”

Section: Statement Of Contributionmentioning

confidence: 99%

Psychological distress among persons with upper extremity limb loss

Armstrong

Williamson

Elliott

et al. 2019

British J Health Psychol

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Objective. We examined predictors of clinically significant levels of psychological distress among individuals with upper limb loss (ULL). Design. A multisite, cross-sectional study completed at six prosthetic rehabilitation centres throughout the United States.Methods. Oral administration of a brief assessment battery to 307 participants with ULL including demographic variables, injury information, screening instruments for PTSD and depression, pain interference, and activity restriction measures. Hierarchical multinomial logit models were conducted. Outcome groups were created using recommended cut-off scores on brief screening measures of depression and PTSD. Final models were assessed including relative risk ratios and marginal effects.Results. Over half of the sample screened positive for depression, PTSD, or both. Eight individuals exceeded the recommended cut-off score indicative of PTSD only (2.6%), and 106 participants (34.5%) screened positive for depression only. Moreover, 64 participants (20.8%) reported co-occurring PTSD and depression. Subsequent models revealed women and ethnic minority participants were more likely to have clinically significant levels of depression and PTSD. Greater restriction in activity and increased pain interference also predicted psychological distress. Conclusions.These findings indicate a significant number of individuals with ULL experience clinically significant levels of psychological distress, and routine clinical assessment of depression and PTSD is warranted. Women and individuals from ethnic minorities may be particularly at risk, regardless of the severity and cause of ULL. Restrictions in preferred and goal-directed activities and persistent pain are

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Prevalence of Depression and Posttraumatic Stress Disorder After Acute Orthopaedic Trauma: A Systematic Review and Meta-Analysis

Abstract: Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Cited by 82 publications

References 51 publications

The association of affective disorders and facial scarring: Systematic review and meta-analysis

The association of affective disorders and facial scarring: Systematic review and meta-analysis

Which orthopaedic trauma patients are likely to refuse to participate in a clinical trial? A latent class analysis

Psychological distress among persons with upper extremity limb loss

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