Mood Changes After Ankle Injuries
Background
The sudden and debilitating nature of lower extremity injuries can trigger mood disturbances, including major depressive disorder. However, little has been published on this topic.
Methods
This prospective study enrolled patients undergoing operative repair of ankle fractures and Achilles ruptures and followed them for one year postoperatively. The validated Patient Health Questionnaire (PHQ-9) for depressive symptoms was administered at the preoperative visit and at postoperative weeks 1, 2, 4, 8, 16, 24, 32, 40, and 52.
Results
Fifty-eight patients completed one-year follow-up. Mean PHQ-9 score was 2.7 (range 0-20) at the preoperative visit, peaked at one postoperative week (4.9, 0-16), and reached its low at 52 postoperative weeks (0.8, 0-7). Cumulative incidences of depressive symptoms during the first year following surgery were 51.7% for at least mild depression, 22.4% for at least moderate depression, and 6.9% for severe depression. History of mental health disorder and the inability to work during the period of postoperative immobilization were independently associated with greater depressive symptoms.
Conclusion
The majority of patients undergoing operative treatment of Achilles ruptures and ankle fractures develop postoperative symptoms of mild-to-moderate depression that normalize after several months. Patients with a history of mental health disorder or who cannot work while immobilized postoperatively are at greatest risk. This information may be used to counsel patients that depressive symptoms are normal following surgery for these injuries, and to target mental health services to patients at risk.
Reference
This study is undergoing peer review. Davison R, Daniel JA, Idarraga AJ, Perticone KM, Bohl DD, Lin J, Holmes GB, Lee S, Hamid KS. Depression Following Operative Treatments for Achilles Ruptures and Ankle Fractures. Submitted to Foot Ankle Int. 2021 Jan.