Musculoskeletal trauma may impact psychological well-being of patients
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A published review article showed patients may experience psychological effects after musculoskeletal trauma which may lead to adverse outcomes, including chronic pain and disability.
Matthew L. Ciminero, MD, and colleagues reviewed recent literature on patients with musculoskeletal trauma and how it pertains to different psychological conditions. Researchers found a 32.6% prevalence of depression after acute orthopedic trauma, which was higher than the estimates of depression in an adult cohort of the United States. Results also showed an increase in anxiety disorders as high as 38% for trauma-related phobias. Another study revealed 20.9% and 35.3% of 101 patients who experienced orthopedic trauma had symptoms of moderate to severe depression and anxiety, respectively, 12 weeks after being discharged from the hospital. Not only did depression independently predict greater postoperative complications, but researchers found patients with symptoms of depression at 12 weeks had increased unexpected adverse events that required readmission.
Results also showed a prevalence of PTSD ranging from 20% to 51% after acute orthopedic trauma. Patients with younger age, unemployment at the time of follow-up, the presence of chronic illnesses, use of a lawyer, blaming others for the injury and having an unsettled compensation claim had an association with PTSD, according to results. Published literature showed a patient’s odds of having post-traumatic stress symptoms increased at 6 months when pain was greater than five on the VAS, patients screened positive for depression, patients scored below average on physical and mental function tests and patients had not yet returned to work.
In terms of interventions, the review article revealed positive psychological factors, such as resilience, social support and self-efficacy, had a protective effect on long-term outcomes. Researchers also noted various psychological treatments, including cognitive-behavioral therapy, relaxation training or mindfulness training strategies, are validated treatments for PTSD, catastrophic thinking, pain anxiety, perceived disability and depression.
However, a survey completed by 350 orthopedic surgeons showed 60% of surgeons reported being “somewhat or very likely” to refer their patients for treatment for psychological problems, despite 90% being “somewhat or very likely” to notice psychological problems in their patients. Orthopedic surgeons reported lack of time, the stigma associated with mental illness and uncertainty of how to refer patients as barriers for referring patients, according to results. Researchers noted teaching surgeons about available resources may improve confidence and competence in managing their patient’s psychological components.
“Our review article offers tools that could be used in both in-patient or office settings, so if a patient is displaying signs of anxiety, depression, PTSD, having difficulty rehabilitating or experiencing pain-control issues, they can quickly and effectively be referred to mental health professionals,” Ciminero said in a press release.
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