New-Onset Depression Is Associated With Low Income and Adverse Arthroplasty-Related Complications
Suin Jeong1, Ji Won Lee2, Elias K Shaya3
1Orthopedics, MedStar Georgetown University Hospital, Washington, USA.
Abstract:
Background and objective Depression may manifest in total joint arthroplasty (TJA) patients even in the absence of any prior history. While research has demonstrated depression to be associated with low socioeconomic status and TJA complications, no studies have explored these associations related to new-onset depression in post-TJA settings. Hence, this study aimed to address that by conducting a retrospective, database-centric study. Methods A national database was queried for data on primary total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients ≥18 years with hip/knee osteoarthritis. Patients with prior depression or antidepressant use, or those with a diagnosis of depression >6 months post-surgery were excluded. The study groups comprised patients with new-onset depression within six months of undergoing TJA; the control groups consisted of those without. Study and controls were matched in a 1:4 ratio in terms of age, sex, and comorbidities. Logistic regressions were employed to assess the associations between new-onset depression and (1) income and (2) one-year complications. Results THA and TKA study groups had 1.48 times (95% CI: 1.40, 1.57) and 1.66 times (95% CI: 1.60, 1.73) higher odds of being in the lower-income class than respective controls. THA study group had 1.93 times (95% CI: 1.50, 2.46), 2.53 times (95% CI: 2.11, 3.01), and 1.56 times (95% CI: 1.31, 1.86) higher odds of periprosthetic fracture, prosthetic joint infection, and revision than controls; the corresponding values for the TKA study group were 1.90 times (95% CI: 1.34, 2.67), 2.33 times (95% CI: 2.06, 2.63), and 1.59 times (95% CI: 1.37, 1.85) compared to controls. Conclusions Low income is associated with the risk of developing new-onset depression post-TJA. New-onset depression is also associated with increased postoperative complications. Future studies may explore whether antidepressant use is beneficial in this population.
