Predictors of Incident Depression After Hip Fracture Surgery

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.

Methods: 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.

Results: 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.

Conclusion: This exploratory study identified two treatable baseline characteristics that predicted incident depression in nondepressed patients after hip-fracture surgery.

Key Words: Hip fracture • depression • incidence • prospective • elderly

Richard C. Oude Voshaar, M.D., Ph.D., Sube Banerjee, F.R.C.P., F.R.C.Psych., Mike Horan, Ph.D., Robert Baldwin, F.R.C.P., F.R.C.Psych., Neil Pendleton, M.D., Ph.D., Rebekah Proctor, Ph.D., Nick Tarrier, Ph.D., Yvonne Woodward, M.Sc., and Alistair Burns, F.R.C.P., F.R.C.Psych.

From the Department of Psychiatry, Nijmegen Medical Centre, Radboud University, Nijmegen, the Netherlands (RCOV); the Department of Mental Health and Ageing, Institute of Psychiatry, London, United Kingdom (SB); the Department of Geriatric Medicine, University of Manchester, United Kingdom (MH, NP); the Department of Clinical Psychology, University of Manchester (RP, NT); and the Department of Old Age Psychiatry, University of Manchester, United Kingdom (RCOV, RB, YW, AB).

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