Introduction
Methods
Eligibility criteria
Search strategy
Study selection
Data extraction
Quality appraisal
Analysis
Results
Study selection
Study characteristics and measures of depression
Author, year | Sample size | Population Characteristics | Prognostic Factors | Outcome Measures | Study Timepoints |
---|---|---|---|---|---|
Bruggeman 2007, Australia [28] | 103 | 78 years 79% female | Personal control, acute stress, illness perception, pain, physical mobility | Depression Anxiety Stress Scale | Study dates not stated Baseline = Within one week of surgery Followed up at 3-weeks |
Cristancho 2016, USA [15] | 430 | 78.2 years 75.8% female 93.7% Caucasian 22.4% clinically diagnosed with new onset depression | Age, gender, medical illness burden, antidepressant use, smoking history, pain ratings, cognitive status, functional recovery, stress ratings, social support, anxiety, history of minor/major depression, implant type | Montgomery- Åsberg Depression Rating Scale, Structured Clinical Interview for DSM-IV disorders (SCID-IV) | 2008–2012 Baseline = approx. 2 days post-surgery Followed up at 1, 2, 4, 8, 12, 26, and 52 weeks after baseline |
Deng, 2005, Taiwan [29] | 146 | 77.7 years > 90% unemployed | Gender, Cognition, Residence status, Prefracture physical function, support system, age, marital status, religion, occupation, diseases before admission | Geriatric Depression Scale – Short Form (GDS-SF) | 2001–2003 Baseline = On admission Followed up at 1 month after discharge |
Langer 2015, USA [30] | 500 | 78.4 years 73.8% women 92.5% white | Positive and negative affect, age, education, gender and social support, chronic illness | The Montgomery Åsberg Depression Rating Scale - 7-day version | Not stated Baseline = 2 to 7 days post-surgery Followed up at Week 1, Week 2, Week 4, Week 8, Week 12, Week 26, and Week 52 post surgery. |
Lenze, 2007, USA [13] | 126 | Major Depressive Disorder group: 78.3 years 16.7% male 100% Caucasian No Major Depressive Disorder group: 81.8 years 20.4% male 91.7% Caucasian 61% MDD cases had onset of MDD symptoms before discharge from the acute care hospital, whereas the other seven had onset of symptoms between 2 and 10 weeks after the hospitalization | Demographic variables and characteristics of the fracture, Functional status, Delirium, cognition, social support, medical comorbidity, Apathy, memory, executive function, Surgery LOS, characteristics of the surgery | Hamilton Depression Rating Scale (Ham-D), Primary Care Evaluation of Mental Disorders | 2002–2004 Baseline = End of hospital stay. Followed up after 2 weeks, then every 4 weeks until 26 weeks post hospital discharge Functional status measured prefracture through interview during hospital stay |
Lenze, 2008, USA [31] | 145 | 81.2 years 95.9% Caucasian woman | Pre-fracture function, comorbidities, ADLs, genetic samples-molecular weight DNA, 5HTR1A and 5HTR2AA | Geriatric Depression Scale | 1998–2004 Baseline = 12 days post-fracture Followed up at 2, 6, and 12-months post-fracture |
Lenze, 2005, USA [32] | 23 | s Allele group: 78.8 years 77% female 100% white l/l Genotype group: 76.2 years 100% female 90% white | Genotype −5-HTTLPR | Hamilton Rating Scale for Depression, mood module of the Structured Clinical Interview for DSM-IV Axis I Disorders | 2002–2003 Baseline = end of their hospital stay Followed up at 2, 6, 10 and 14 weeks after hospital discharge |
Liu 2018, Taiwan [33] | 179 | 76.7 years 68.2% female Average number of comorbidities was 2.45 | Age, gender, marital status, educational level, comorbidities, cognitive impairment, functional impairment, care model and group membership probability, prefracture mobility | Geriatric Depression Scale-Chinese version | 2005–2010 Baseline = before discharge Followed up at 1, 3, 6, and 12-months post- discharge |
Matheny, 2011, USA [34] | 134 | 81.7 years 96.3% Caucasian All participants were female | Age, height, weight, comorbidities, cognitive status, inflammatory cytokines, lower extremity function | Geriatric Depression Scale (GDS) | 1998–2004 Baseline-within 22 days post-hip fracture Followed up at 2, 6 and 12-months post fracture |
Shyu 2009, Taiwan [10] | 147 | 77.9 years 67.3% female 49% illiterate | Gender, age, concomitant illnesses, prefracture performance of ADLs, education, emotional-social support, and cognitive status. | Geriatric Depression Scale-Chinese version | 2001–2003 Baseline = prior to discharge Followed up at 1, 3, 6 and 12 months after hospital discharge |
Van der Ree, 2020, Netherlands [14] | 570 | 78.4 years 393 females 46.3% frail 3.7% had early-onset dementia | Age, gender, ASA, Prefracture residential status, Fracture type, LOS, Discharge location, Pre-fracture health status, Pre-fracture frailty | Hospital Anxiety and Depression Scale (HADS) | 2015–2016 Baseline = 1 week after hip fracture. Followed up at 1, 3, 6 and 12 months after hip fracture. |
Voshaar 2007, the Netherlands [35] | 139 | 80.7 years 77% women | Pain, fear of falling, anxiety, functional outcomes | Geriatric Depression Scale, The Montgomery Åsberg Depression Rating Scale, Hospital Anxiety and Depression Scale | Baseline = not described Followed up at six weeks, three months, and six months |
Risk of bias in studies
Author, year | Study participation | Study attrition | Prognostic factor measurement | Outcome measurement | Study confounding | Statistical analysis/reporting |
---|---|---|---|---|---|---|
Bruggeman 2007, Australia [28] | moderate | high | moderate | low | moderate | Low |
Cristancho 2016, USA [15] | low | high | moderate | low | high | moderate |
Deng, 2005, Taiwan [29] | low | high | high | high | high | high |
Langer 2015, USA [30] | moderate | high | low | low | high | moderate |
Lenze, 2007, USA [13] | low | low | low | low | moderate | moderate |
Lenze, 2008, USA [31] | low | moderate | low | low | low | moderate |
Lenze, 2005, USA [32] | low | low | low | low | high | high |
Liu 2018, Taiwan [33] | low | moderate | moderate | low | moderate | high |
Matheny, 2011, USA [34] | low | high | moderate | low | low | high |
Shyu 2009, Taiwan [10] | low | low | moderate | low | high | high |
Van der Ree, 2020, Netherlands [14] | low | moderate | low | low | high | low |
Voshaar 2007, the Netherlands [35] | low | moderate | moderate | low | high | moderate |
Prognostic factors
Author, year | Analysis | Effect Estimate/Result | Proposed Mechanism |
---|---|---|---|
Bruggeman 2007, Australia [28] | Hierarchical multivariable regression | Adjusted R2, Overall Model F Personal control predicting Depression: 0.43, F (4, 52) Personal control and hopelessness predicting depression: 0.55, F (5, 46) Personal control beliefs predicted depression severity when entered alone, this relationship became nonsignificant when hopelessness scores were entered Depression at T1 and pain at time T2 were significant predictors of depression | N |
Cristancho 2016, USA [15] | Multinomial logistic regression model | Odds Ratio Age: 1.04 (0.98–1.10) Antidepressant use: 4.61 (1.46–14.61) Anxiety traits: 1.49 (1.25–1.78) CIRS-G co-morbidities: 1.05 (0.92–1.20) FRS mobility score: 1.02 (0.89–1.17) GALES stress rating: 1.38 (1.17–1.64) Gender 0.39 (0.12–1.26) Implant: type – internal fixation with screws: 2.75 (0.77–9.77) Implant type – sliding hip screw – IM nail, other: 7.94 (2.31–27.31) History of depression: 4.02 (1.13–14.28) Pain rating scale: 1.09 (0.92–1.30) SBT cognitive score: 1.07 (0.91–1.24) Smoking status – current: 5.11 (1.09–24.00) Smoking status – past: 1.67 (0.52–5.31) Social network: 1.09 (0.98–1.22) Subjective support: 1.39 (1.12–1.72) | N |
Deng, 2005, Taiwan [29] | Logistic regression | Odds Ratio Gender: 5.486 (2.088–14.416) Complete cognition: 0.434 (0.143–1.321) Fixed residence: 0.482 (0.099–2.338) Dependent physical function before fracture: 6.021 (2.034–137.823) Supporting system: 0.981 (0.940–1.023) | Y |
Langer 2015, USA [30] | Auto-regressive latent trajectory (ALT) analyses | Fully standardized parameter used (no further description given) Depression: Negative affect intercept: 0.48 Negative affect slope: 0.56 Slower decline in negative affect predicted higher depression at Week 52 | Y |
Lenze, 2007, USA [13] | Repeated-measures mixed-effects model; Univariable and Multivariable Logistic Regressions | Odds Ratio Univariate: Age: 0.96 (0.91–1.01) Male: 1.28 (0.34–4.81) Cumulative Illness Rating Scale score: 0.98 (0.84–1.14) Prefracture FIM motor subscale score: 1.01 (0.96–1.06) Post fracture FIM motor subscale score: 1.01 (0.96–1.05) Sub capital fracture: 0.65 (0.23–1.86) Prosthetic joint surgery: 0.76 (0.26–2.17) Surgical LOS: 1.04 (0.92–1.19) Apathy Evaluation Scale score: 1.09 (1.03–1.16) Delirium Rating Scale score: 1.07 (0.99–1.16) MMSE: 1.01 (0.88–1.15) Logical Memory Test score: 1.03 (0.89–1.19) Mattis Initiation-Perseveration scale: 0.93 (0.83–1.04) Social support: 0.97 (0.91–1.03) Multivariate: Apathy: 1.09 (1.02–1.15) Delirium: 1.05 (0.96–1.15) Individuals with clinical evidence of apathy are at high risk for developing MDD or depressive symptoms | N |
Lenze, 2008, USA [31] | General linear regression models – time-adjusted model and covariate and time-adjusted model | Estimated mean difference Covariate and time-adjusted model: 5HTR1A only: 0.66 (0.18, 1.14) 5HTR2A only: 0.44 (−0.10, 0.98) 5HTR1A and 5HTR2A combined: 5HTR1A: 0.61 (0.13, 1.09) 5HTR2A: 0.37 (− 0.16, 0.91) The 5HTR1A promoter polymorphism is associated with depressive symptoms in elderly persons after a hip fracture. The G allele of the 5HTR1A (− 1019) polymorphism was associated with increased depressive symptoms for 12 months after the fracture | Y |
Lenze, 2005, USA [32] | Repeated-measures analysis of variance | Only baseline data given The s allele of the 5-HTTLPR is predictive of having MDD and high depressive symptoms after hip fracture | N |
Liu 2018, Taiwan [33] | Binary logistic regression modelling | Coefficient estimate/b Number of comorbidities: −0.27 (− 0.54, − 0.00) Pre-fracture mobility: 0.11 (0.04, 0.18) Other results not given Patients were more likely to be in the progressively lower-risk group than in the fluctuating higher-risk group if they had fewer comorbidities or better prefracture mobility | N |
Matheny, 2011, USA [34] | Generalized estimating equations (GEE) | Not given, only p-values We found that hip fracture patients in the highest group of inflammatory cytokine levels for both IL-6 and sTNF-αR1 had higher levels of depressive symptoms than those in the lowest group, particularly at 12 months post fracture. | Y |
Shyu 2009, Taiwan [10] | Multivariable logistic regression | Effect Estimates not given Those who were female (P < 0.001), with lower prefracture performance of ADLs (P < 0.001) and with lower emotional-social support (P < 0.001) were more likely to be at higher risk for depressive symptoms. Lower emotional-social support was the only predictor for persistent depressive symptoms after discharge None of the predictors in the model were statistically significantly associated with depressive symptoms after discharge. | N |
Van der Ree, 2020, Netherlands [14] | Univariable and Multivariable Logistic Mixed Model | Odds Ratio Multivariable including frailty Age ≥ 80 years: 1.61 (0.87–2.99) Female gender: 0.87 (0.48–1.57) ASA III/IV/V: 1.97 (0.94–4.12) Prefracture residential status: 0.92 (0.29–2.90) Prefracture mobility: With aid: 0.89 (0.44–1.78) Dependent: 1.54 (0.46–5.13) Type of fracture: extracapsular: 1.50 (0.85–2.65) Length of hospital stay (days): 1.11 (1.04–1.20) Discharge location: Institution: 2.20 (1.12–4.34) Frailty: 2.74 (1.41–5.34) Higher ASA scores, dependence in locomotion at baseline, longer LOS at hospital, and discharge to an institution were prognostic factors for symptoms of depression during 1 year after hip fracture Frailty at onset of hip fracture was the most important prognostic factor of symptoms of depression on average in the year following hip fracture | N |
Voshaar 2007, the Netherlands [35] | Cox proportional hazards model | Hazard Ratio Postoperative pain: 1.32 (1.14–1.53) Baseline anxiety: 1.25 (1.08–1.44) The independent predictors that were associated with incident depression yielded postoperative pain and baseline anxiety as the strongest, independent risk factors | N |