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. Methods: 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. Patients who had histories of any form of depression or femoral neck fracture before the study period were not included. 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 groups after adjusting for residence and socio-demographic characteristics. The most common physical comorbidities that were present after the fracture were also analyzed.Results: Fifty-five (1.2%) femoral neck fracture patients and 95 (0.7%) non-fracturecomparison patients were diagnosed with major depression during the study period. The stratified Cox proportional analysis showed a covariate-adjusted HR 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. Peptic ulcers (40.0%) were the most common comorbidity after fracture that differed between the study and comparison patients (PConclusion: 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.
Jr-Hau Wu, Changhua Christian Hospital, Taiwan
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