Patterns of Depressive Symptoms Before and After Surgery for Osteoarthritis: A Descriptive Study

Abstract

Objective: To examine patterns of depressive symptoms before and over the year following osteoarthritis (OA) surgery, stratified by joint and postsurgical outcome.

Methods: Participants were hip (n = 287), knee (n = 360), and lumbar spine (n = 100) OA patients scheduled for joint replacement or decompression surgery with or without fusion. One pre- and 4 postsurgery questionnaires were completed. Depressive symptoms were quantified using the Hospital Anxiety and Depression Scale (HADS). One-year outcomes were based on Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scores for hip and knee patients and Oswestry Disability Index (ODI) scores for spine patients and were categorized as "worse" (top score tertile) vs. "better" outcomes (first, second tertiles). Plots over time were generated by joint and outcome: 1) mean pain/disability and depression scores and 2) percentage of patients meeting HADS cut-off for depression "caseness," reporting depression diagnosis and treatment.

Results: There were notable decreases in depression scores for patients with better outcomes. For those with worse outcomes, decreases were smaller for hip patients and were not significant for knee and spine patients. Among those with poorer outcomes, 25% of spine and knee patients were depression "cases" pre- and postsurgery; an additional 16% of spine and 10% of knee patients developed new "caseness" postsurgery. The proportion of these patients deemed depression cases by score was much higher than the proportion reporting diagnosis/treatment.

Conclusion: Although depressive symptoms decrease overall in OA patients postsurgery, degrees of change vary by joint and surgical outcome. Greater attention to mental health postsurgery is warranted and may lead to improved surgical outcomes, particularly among knee and spine patients.

Figure 1

Hip OA patients. A and B, Trajectories of mean depressive symptom and pain scores. Depressive symptom scores derived from the Hospital Anxiety and Depression Scale (HADS). Pain scores are derived from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale. Scores for depressive symptoms and pain range from 0 to 100 with a higher score indicating greater symptom severity. C and D, Trajectories of HADS caseness of depression, self‐reported depression, and treatment for depression. Caseness of depression defined as HADS scores ≥ 38.1/100, equivalent to 8/21 before rescaling. All are measured stratified by 1‐year postsurgical outcome.

Figure 2

Knee patients. A and B, Trajectories of mean depressive symptom and pain scores. Depressive symptom scores derived from the Hospital Anxiety and Depression Scale (HADS). Pain scores are derived from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale. Scores for depressive symptoms and pain range from 0 to 100 with a higher score indicating greater symptom severity. C and D, Trajectories of HADS caseness of depression, self‐reported depression, and treatment for depression; Caseness of depression defined as HADS scores ≥ 38.1/100, equivalent to 8/21 before rescaling. All are measured stratified by 1‐year postsurgical outcome.

Figure 3

Lumbar spine patients. A and B, Trajectories of mean depressive symptom and pain‐related disability scores; depressive symptom scores derived from the Hospital Anxiety and Depression Scale (HADS). Pain‐related disability scores are derived from the Oswestry Disability Index (ODI). Scores for depressive symptoms and pain‐related disability range from 0 to 100, with a higher score indicating greater symptom severity. C and D, Trajectories of HADS caseness of depression, defined as HADS scores ≥ 38.1/100 and equivalent to 8/21 before rescaling, self‐reported depression, and treatment for depression. All are measured stratified by 1‐year postsurgical outcome.