Comparative study of anxiety and depression following maxillofacial and orthopedic injuries. Study from a Nigerian University Teaching Hospital.

Ramat Oyebunmi Braimah,Kizito Chioma Ndukwe,Akinyele Lawrence Akinyoola,Dominic Ignatius Ukpong

doi:10.1002/cre2.90

Abstract

This study hopes to compare levels of anxiety and depression in the maxillofacial and orthopedic injured patients over a period of 12 weeks. This was a prospective, repeated measure design. A total of 160 participants (80 with maxillofacial and 80 with long bone fractures) had repeated review follow‐ups within 1 week of arrival in the hospital (Time 1), 4–8 weeks after initial contact (Time 2) and 10–12 weeks thereafter (Time 3), using hospital anxiety and depression scale questionnaire. Road traffic accident remained the main cause of injury in both groups of subjects. The Hospital anxiety and Depression scale detected 42 (52.5%) cases of depression at baseline, 36 (47.4%) cases at Time 2, and 14 (18.4%) cases at Time 3 in the maxillofacial injured group. In the long bone fracture subjects, 47 (58.8%) cases were depressed at baseline, 23(33.3%) cases at Time 2, and only 5 (7.2%) cases at Time 3. Both groups showed reduction in depression levels with time. Fifty‐six (70.0%) had anxiety at baseline, 32 (42.1%) at Time 2, and only 9 (11.8%) had anxiety at Time 3 in the maxillofacial fracture group, whereas in the long bone fracture group, 69 (86.3%) subjects were anxious at baseline, 32 (46.4%) at Time 2, and 22 (31.9%) at Time 3. There were significant differences in depression and anxiety level in both the maxillofacial and the long bone fracture subjects at baseline (Time 1), Time 2(4–8 weeks) and Time 3(10–12 weeks).

Highlights

The psychological needs of patients with acquired facial trauma are unique and very important
It has been noted that patients with orofacial trauma were more likely to report symptoms of depression, anxiety, and hostility when compared to a matched normal control group for a period of up to 1 year post trauma (Bisson, Sheperd, & Dhutia, 1997)
In the long bone fracture subjects, 47 (58.8%) cases were depressed at baseline, 23(33.3%) cases at Time 2, and only 5 (7.2%) cases at Time 3 (These are subjects that scored above the cut‐ off point of 7 on the Depression scale of the Hospital anxiety and depression scale (HADS))

Summary

Introduction

The psychological needs of patients with acquired facial trauma are unique and very important. Many studies have reported that 10–70% patients based on various factors may experience symptoms of depression and anxiety after facial trauma (Bisson et al, 1997) This may be coupled with the fact that patients with orofacial trauma have psychosocial problems such as unemployment, lower education level, and poor social support. (Levine, Degutis, Pruzinsky, Shin, & Persing, 2005) The symptoms of depression and anxiety in many cases may be subthreshold and may not meet the full diagnostic criteria of a psychiatric disorder This may often lead to diagnostic dilemmas, poor treatment of the problem, and poor intervention. Depression places the patient at increased risk for committing suicide, poor compliance with treatment, and poor rehabilitation outcome This in turn will affect the quality of life and recovery from the facial trauma (Cuijpers & Smit, 2004; Meningaud, Benadiba, Servant, Bertrand, & Pelicier, 2003)

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