Increased risk of major depression in the three years following a femoral neck fracture--a national population-based follow-up study

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.

Figure 1. Flowchart of the selection methods in study and comparison patients.

^a The LHID contained medical records of one million people, which was randomly selected from the Taiwan National Health Insurance (NHI) program (supported by Taiwan government and over 98% of the Taiwanese population was enrolled in this program). ^b All personal medical records (diagnosis, treatments, medications), which had been recorded by different hospitals, were finally input into the NHI for requiring payments. Because almost all hospitals in Taiwan have joined the NHI; therefore, we could use it to screen patients’ past histories. ^C Three comparison patients for each femoral neck fracture patient (matched with study group patients in terms of sex, age and years of healthcare use).

Figure 2. Time-related factor associated with the major depression occurrence.

(A) Major depression-free survival curves for patients with femoral neck fracture and the comparison patients during the 3-year follow-up period (p = <0.001).

Figure 3. Most major depressive episodes (34.5%) occurred within the first 200 days following femoral neck fracture.

The percentage of major depression patients also gradually decreased as the observation period prolonged.