Abstract
Femoral neck fracture is common in the elderly, and its impact has increased in aging societies. Comorbidities, poor levels of activity and pain may contribute to the development of depression, but these factors have not been well addressed. This study aims to investigate the frequency and risk of major depression after a femoral neck fracture using a nationwide population-based study. The Taiwan Longitudinal Health Insurance Database was used in this study. A total of 4,547 patients who were hospitalized for femoral neck fracture within 2003 to 2007 were recruited as a study group; 13,641 matched non-fracture participants were enrolled as a comparison group. Each patient was prospectively followed for 3 years to monitor the occurrence of major depression. Cox proportional-hazards models were used to compute the risk of major depression between members of the study and comparison group after adjusting for residence and socio-demographic characteristics. The most common physical comorbidities that were present after the fracture were also analyzed. The incidences of major depression were 1.2% (n = 55) and 0.7% (n = 95) in the study and comparison groups, respectively. The stratified Cox proportional analysis showed a covariate-adjusted hazard ratio of major depression among patients with femoral neck fracture that was 1.82 times greater (95% CI, 1.30–2.53) than that of the comparison group. Most major depressive episodes (34.5%) presented within the first 200 days following the fracture. In conclusion, patients with a femoral neck fracture are at an increased risk of subsequent major depression. Most importantly, major depressive episodes mainly occurred within the first 200 days following the fracture.
Highlights
Femoral neck fracture is a common medical problem in patients over 60 years old
[6] Physical complications after femoral neck fracture, including increased comorbidities, poor self-care in functional and routine activities (40%) and acute or chronic pain (60%), have been reported. [7,8,9,10] Overall, high mortality rates are associated with hip fracture; recent studies have reported that the one-year mortality rate ranged from 14.7% (Korea) to 41.7% (Spain). [11,12,13,14] Acute stress and poorer quality of life are usually present in most femoral neck fracture patients
3.2 Depression Likelihood based on the Crude hazard ratio (HR) During the 3-year follow-up period, we found that the risk of presenting with new-onset major depression was significantly higher in patients with femoral neck fracture than in comparison patients
Summary
Femoral neck fracture is a common medical problem in patients over 60 years old. The incidence of this type of fracture is generally reported to be as high as 10%. [1,2,3] As the average life expectancy of the population increases, the number of femoral neck fractures increases each year; [4,5] one previous study further predicted that the incidence of hip fracture will double by the year 2050. Some previous studies have reported that hip fracture could increase the chance of suffering depressive symptoms (including anxiety and insomnia) in patients with older age or poorer quality of life; [16,17] no published study has focused on major depression. Major depression presents with more severe psychosis symptoms, and the principles of diagnosis must establish, through rigorous criteria, doi:10.1371/journal.pone.0089867.g001
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