Integration of collaborative care model ameliorates population level COVID-19 Pandemic-related depressive symptoms among orthopaedic clinic patient population in US major metropolitan area

Abstract

Background: In the United States, the COVID-19 pandemic resulted in a widespread mental health crisis. Overarchingly, medical clinics have been slow to adopt an interdisciplinary approach to patient care, though depression has been shown to negatively affect many clinical outcomes. With an ongoing, worsening mental health crisis in conjunction with a dramatic increase in demand for Total Joint Replacement anticipated by 2030, more routine depression screening and adequate mental health support is imperative. Our clinic implemented a Collaborative Care Model (CCM) in March of 2020 with a Licensed Clinical Social Worker (LCSW). Methods: Using data collected at our outpatient clinic between September 1, 2018 and August 31, 2021, we compared changes in Patient-Reported Outcome Measurements Information System (PROMIS) depression scores from the group of patients seen before CCM adoption (“pre-CCM”) with scores from the group after (“post-CCM”). Results: We found no between-group differences in PROMIS depression score changes. Increased pain interference was positively associated with increased depression in the pre-CCM group, but not in the post-CCM group. Conclusions: Our CCM was successful in mitigating for our patients the mental health crisis reflected among the general population during the lockdowns and uncertainty of the COVID-19 pandemic. The CCM also diminished further exacerbation of depression secondary to increased pain interference and the overall impact the pandemic had on healthcare operations. A CCM inclusive of an LCSW may also further support community resource linkage, complex care coordination, and assessment of other mental health conditions related to orthopaedic conditions or injury, such as anxiety and post-traumatic stress disorder.