Psychological Medicine

Original Articles

The effect of post-injury depression on return to pre-injury function: a prospective cohort study

T. S. Richmonda1 c1, J. D. Amsterdama2, W. Guoa3, T. Ackersona4, V. Graciasa5, K. M. Robinsona6 and J. E. Hollandera7

a1 School of Nursing, Biobehavioral and Health Sciences Division, University of Pennsylvania, Philadelphia, PA, USA

a2 School of Medicine, Depression Research Unit, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA

a3 School of Medicine, Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA

a4 School of Nursing, University of Pennsylvania, Philadelphia, PA, USA

a5 School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA

a6 School of Medicine, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA

a7 School of Medicine, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA

Abstract

Background Millions of people seek emergency department (ED) care for injuries each year, the majority for minor injuries. Little is known about the effect of psychiatric co-morbid disorders that emerge after minor injury on functional recovery. This study examined the effect of post-injury depression on return to pre-injury levels of function.

Method This was a longitudinal cohort study with follow-up at 3, 6 and 12 months post-injury: 275 adults were randomly selected from those presenting to the ED with minor injury; 248 were retained over the post-injury year. Function was measured with the Functional Status Questionnaire (FSQ). Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR disorders (SCID).

Results During the post-injury year, 18.1% [95% confidence interval (CI) 13.3–22.9] were diagnosed with depression. Adjusting for clinical and demographic covariates, the depressed group was less likely to return to pre-injury levels of activities of daily living [odds ratio (OR) 8.37, 95% CI 3.78–18.53] and instrumental activities of daily living (OR 3.25, 95% CI 1.44–7.31), less likely to return to pre-injury work status (OR 2.37, 95% CI 1.04–5.38), and more likely to spend days in bed because of health (OR 2.41, 95% CI 1.15–5.07).

Conclusions Depression was the most frequent psychiatric diagnosis in the year after minor injury requiring emergency care. Individuals with depression did not return to pre-injury levels of function during the post-injury year.

(Received August 14 2008)

(Revised December 22 2008)

(Accepted January 11 2009)

(Online publication March 02 2009)

Correspondence

c1 Address for correspondence: T. S. Richmond, Ph.D., CRNP, Associate Professor, University of Pennsylvania, School of Nursing, Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104, USA. (Email: terryr@nursing.upenn.edu)

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