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High prevalence of depression found in patients with cervical spine diagnoses
This may affect perioperative and postoperative care in these patients, investigators noted.
There is a high concomitant prevalence of depression among patients who had cervical spine diagnoses, along with significant gender differences and age-related trends, according to the results of a retrospective analysis.
“Knowledge of any of these trends in the preoperative state may affect your decision making about the perioperative care and postoperative care in these patients,” orthopedic surgery resident Richard J. Myers, MD, who is at the Oregon Health and Science University, in Portland, Ore., said during a presentation of the study.
Myers and colleagues identified 272 consecutive patients who had cervical spine surgery between 2007 and 2011 from the university’s prospective registry. For their outcome measures, the researchers used the Short-Form 12 Health Survey Mental and Physical Component Summary (MCS and PCS) scores.
Two definitions of depression
For the analysis, two researchers reviewed the patients’ medical charts for demographics (ie, age, gender and body mass index) and surgical history; a third researcher reconciled these findings for accuracy.
When depression was defined as a SF-12
Mental Component Summary less than
45 points, 50% of women with a cervical
spine diagnosis were depressed.
Image: Myers RJ
“The key here is we defined depression in two different ways,” Myers said. “First, we defined it as a chart diagnosis … something that was documented in the medical record, either by primary care or psychiatric provider, or as an MCS less than 45, which has been shown to be valid in the literature,” he said.
Depression, gender link
Based on the preoperative diagnoses, 42% of women were depressed vs. 16% of men (P<0.01). When the investigators defined depression as an MCS score of <45, half of the women were identified as depressed.
“[There was an] especially big jump in male patients, jumping from 16% to 36%” with the MCS score definition of depression, Myers said.
Of the men in the study, 61 out of the 67 who were depressed did not have a chart diagnosis.
“I would posit that there are a lot of our patients who come into our clinics preoperatively who are not necessarily hiding their depression, but [who] have some concomitant depression that may affect postoperative results,” Myers said.
Preoperative MCS and PCS scores were lower for women compared with men (MCS 43.6 + 12.7 vs. 46.9 + 12.6; P=0.04; PCS, 29.8 + 9.2 vs. 33.4 + 10.1; P<0.01).
Patients with psychiatric diagnoses had dramatically lower MCS and PCS scores, according to Myers.
“Finally, looking at the rates of depression as compared to the age group, there was a striking linear correlation of decreasing rates of depression in our female patients whereas it was pretty level across all age groups with our male patients, with our youngest patients having the highest rates of depression,” he said.
“I will acknowledge that the diagnosis and definition of depression can be highly variable in all patient cohorts let alone the cervical population,” Myers said. “It does not necessarily relate to postoperative outcome.” – by Colleen Owens
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Disclosure: Myers has no relevant financial disclosures.
Perspective
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The authors ought to be congratulated on an elegant study concept and design. The study highlights several important points. Firstly, it is clear that having a prospectively collected patient registry, such as the authors had access to, can allow the development of fascinating insights into the outcomes of our patients. Secondly, there was a surprisingly high incidence of depression in this population of patients who underwent cervical spine surgery. Finally, women seem to have more insight into their mental health condition and reported a substantially higher incidence of depression than did men. What is unknown from this study is whether a patient’s preoperative somatic pain or other symptoms may have played a role in the development of the depression. What is also unknown is whether these preoperative mental component scores had an adverse effect on the patient’s eventual surgical outcome. A more comprehensive understanding of our patients’ health condition will improve our ability to provide superior surgical outcomes. I look forward to more data from these authors on these issues.