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• W2976845906 abstract "Commentary Musculoskeletal injury and impairment cause mental health issues in addition to physical symptoms. This is particularly true for elite athletes, whose lives revolve around their ability to function at the highest levels both physically and mentally. Sports psychiatry and psychology is an important subspecialty field of mental health dedicated to mitigating psychological symptoms in athletes. However, like most things in medicine, addressing the underlying cause is fundamental to treatment success, and, in the case of recurrent shoulder instability, stabilization is the prescription that is needed for most patients. We commend Weekes et al. on their excellent study of depressive symptoms in patients undergoing arthroscopic labral repair stabilization for recurrent shoulder instability. The findings are provocative, reporting a preoperative prevalence of clinical depression among a cohort of patients with recurrent shoulder instability of 51% as defined by a score ≥6 on the Quick Inventory of Depressive Symptomatology-Self Report (QIDS-SR). This is a higher prevalence than in patients undergoing anterior cruciate ligament (ACL) reconstruction (42%) using the same methodology1 and may reflect the chronic nature of recurrent shoulder instability. The prevalence of greater symptom severity that was potentially indicative of major depressive disorder (QIDS-SR ≥10 points) was reported to be 25% preoperatively in this current study, which is more similar to a recent meta-analysis of patients with acute trauma that found a weighted pooled prevalence of depression of 32.6%2. It is certainly reassuring that the depressive symptoms improve after shoulder stabilization for most patients, but the persistent clinical depression in 24% at 1 year postoperatively is concerning. This is more than double the reported rate at 1 year in patients who had undergone ACL reconstruction (9.4%), and it was more comparable with the rate at 2 years after orthopaedic trauma of 26.7%1. It is also noteworthy that there was a transient increase in depressive symptoms for all groups at 6 weeks after shoulder stabilization. It is also important to note that the group that did not meet the criteria of clinical depression still had some preoperative depressive symptoms, with a mean QIDS-SR of 4 points, which then improved to 0 points by 1 year. The relationship between function and depressive symptoms is very interesting. Patients with clinical depression reported worse preoperative function and worse postoperative function, but improve to a similar degree as those without clinical depression. This is consistent with other studies and likely reflects the complex interplay between physical and mental dysfunction. However, it is also possible that this is due to response bias and simply reflects an inclination to pick similar responses across the questionnaires. Furthermore, patients with depression frequently have concentration impairment that may further accentuate response bias. Patients’ expectations of treatment are very important and have been shown to be the most important predictor of outcome of treatment of rotator cuff tears3,4. Although patients’ expectations were not assessed in the current study by Weekes et al., they were assessed in the previous study of patients undergoing ACL reconstruction1. Interestingly, there was no observed difference in preoperative expectations between those patients undergoing ACL reconstruction with depressive symptoms and those without depressive symptoms. This strongly argues against response bias as an explanation for the findings in that study and likely the current study as well. The findings of the study by Weekes et al. and other studies raise the very important question about the role of the orthopaedic surgeon in identifying and addressing mental health distress. Orthopaedic surgeons are physicians first and not just technicians who fix tears, and they therefore must be part of the solution for these patients. It is clear that withholding elective orthopaedic surgery from patients with depressive symptoms is illogical, but identifying and addressing depressive symptoms seem warranted. Referring these patients to our psychiatric colleagues for appropriate mental health treatment may help with the outcomes of our surgical interventions. A randomized study on this approach seems reasonable. Future studies should also comprehensively assess other factors that are related to outcomes, such as patients’ expectations, as well as comorbid anxiety and posttraumatic stress disorder (PTSD) symptoms. The prevalence of PTSD after orthopaedic trauma is 26.6%2, and may be even higher in patients with recurrent shoulder instability, who are reexperiencing the trauma. Finally, the next generation of patient-based outcome instruments that utilize computer-based testing to minimize the question burden, such as the Patient-Reported Outcomes Measurement Information System (PROMIS), may be particularly useful in future studies5." @default.
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• W2976845906 date "2019-09-18" @default.
• W2976845906 modified "2023-10-16" @default.
• W2976845906 title "Chicken Soup for the Unstable Shoulder: Stabilization Reduces Depressive Symptoms" @default.
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• W2976845906 doi "https://doi.org/10.2106/jbjs.19.00760" @default.
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