TY - JOUR
T1 - A Population-Based Assessment of Depression and Anxiety in Patients With Brachial Plexus Injuries
AU - Yannascoli, Sarah M.
AU - Stwalley, Dustin
AU - Saeed, Mohammed J.
AU - Olsen, Margaret A.
AU - Dy, Christopher J.
N1 - Funding Information:
The Center for Administrative Data Research (D.S., M.J.S., and M.A.O.) is supported in part by the Washington University Institute of Clinical and Translational Sciences grant number UL1 TR000448 from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH), grant number R24 HS19455 through the Agency for Healthcare Research and Quality (AHRQ), and grant number KM1CA156708 through the National Cancer Institute at the NIH. C.J.D. was supported by grant UL1 TR000448, Subaward KL2 TR000450 from NCATS, components of the NIH, and NIH Roadmap for Medical Research.
Publisher Copyright:
© 2018 American Society for Surgery of the Hand
PY - 2018/12
Y1 - 2018/12
N2 - Purpose: Reactive depression and anxiety are common after major life changes such as brachial plexus injuries (BPI). The purpose of this study was to evaluate the incidence and risk factors for coded depression and coded anxiety among patients with BPI using a national database of commercial insurance claims. Methods: We used the Truven MarketScan database from 2007 to 2013 to identify commercially insured patients aged 18 to 64 years who underwent BPI surgery. For comparison, a control group without BPI was frequency-matched 10:1 by age group, sex, number of provider visits, and length of insurance enrollment. Using International Classification of Diseases, Ninth Revision diagnosis codes and pharmacy claims, we identified coded depression and coded anxiety in the 12 months before and 12 months after BPI surgery. Multivariable Cox regression models were used to determine risk factors for coded depression or coded anxiety, adjusting for known risk factors for depression or anxiety (eg, alcohol, substance abuse). Results: We identified 1,843 patients with BPI and 18,430 controls. Within the 12 months preceding surgery, coded depression and coded anxiety were present in 38% and 42%, respectively, of the BPI group; both were present in 25% and either was present in 54%. The rate of new-onset/postoperatively coded depression among patients with BPI was 142.1/1,000 person-years (12%) and of new-onset/postoperatively coded anxiety was 273.6/1,000 person-years (20%). Patients with BPI were significantly more likely than controls to develop new-onset/postoperatively coded depression (hazard ratio = 1.3; confidence interval [CI], 1.1–1.5) and new-onset/postoperatively coded anxiety (HR = 2.1 [CI, 1.8–2.4]). Conclusions: Patients undergoing BPI surgery have a high prevalence of coded depression and coded anxiety in the 12 months before surgery and are at higher risk for developing new-onset/postoperatively coded depression and coded anxiety within 1 year after surgery. These findings can be used by BPI surgeons to inform perioperative counseling, guide emotional recovery from injury, and facilitate coordinated or colocated care with mental health professionals. Type of study/level of evidence: Prognostic II.
AB - Purpose: Reactive depression and anxiety are common after major life changes such as brachial plexus injuries (BPI). The purpose of this study was to evaluate the incidence and risk factors for coded depression and coded anxiety among patients with BPI using a national database of commercial insurance claims. Methods: We used the Truven MarketScan database from 2007 to 2013 to identify commercially insured patients aged 18 to 64 years who underwent BPI surgery. For comparison, a control group without BPI was frequency-matched 10:1 by age group, sex, number of provider visits, and length of insurance enrollment. Using International Classification of Diseases, Ninth Revision diagnosis codes and pharmacy claims, we identified coded depression and coded anxiety in the 12 months before and 12 months after BPI surgery. Multivariable Cox regression models were used to determine risk factors for coded depression or coded anxiety, adjusting for known risk factors for depression or anxiety (eg, alcohol, substance abuse). Results: We identified 1,843 patients with BPI and 18,430 controls. Within the 12 months preceding surgery, coded depression and coded anxiety were present in 38% and 42%, respectively, of the BPI group; both were present in 25% and either was present in 54%. The rate of new-onset/postoperatively coded depression among patients with BPI was 142.1/1,000 person-years (12%) and of new-onset/postoperatively coded anxiety was 273.6/1,000 person-years (20%). Patients with BPI were significantly more likely than controls to develop new-onset/postoperatively coded depression (hazard ratio = 1.3; confidence interval [CI], 1.1–1.5) and new-onset/postoperatively coded anxiety (HR = 2.1 [CI, 1.8–2.4]). Conclusions: Patients undergoing BPI surgery have a high prevalence of coded depression and coded anxiety in the 12 months before surgery and are at higher risk for developing new-onset/postoperatively coded depression and coded anxiety within 1 year after surgery. These findings can be used by BPI surgeons to inform perioperative counseling, guide emotional recovery from injury, and facilitate coordinated or colocated care with mental health professionals. Type of study/level of evidence: Prognostic II.
KW - Anxiety
KW - brachial plexus
KW - depression
KW - mental health
KW - nerve injury
UR - http://www.scopus.com/inward/record.url?scp=85047218312&partnerID=8YFLogxK
U2 - 10.1016/j.jhsa.2018.03.056
DO - 10.1016/j.jhsa.2018.03.056
M3 - Article
C2 - 29789186
AN - SCOPUS:85047218312
SN - 0363-5023
VL - 43
SP - 1136.e1-1136.e9
JO - Journal of Hand Surgery
JF - Journal of Hand Surgery
IS - 12
ER -