“The Impacts of Anxiety and Depression on Outcomes in Orthopaedic Trauma Surgery: A Narrative Review” by Weinerman et al. (Annals of Medicine & Surgery, October 2, 2023)
- rajaduttamd
- Jul 31, 2025
- 2 min read
🧠 Overview & Key Messages
Authors & ContextJonathan R. Weinerman and colleagues conducted this open access narrative review to synthesize existing literature on how anxiety and depression affect surgical outcomes in orthopedic trauma patients PMC.
Prevalence of Psychiatric DisordersPrevalence among orthopaedic trauma patients reaches up to ~45%, with anxiety and depression being the most common psychiatric conditions ScienceDirect+12PMC+12BioMed Central+12.
⚠️ Impacts on Surgical and Recovery Outcomes
Negative predictors: Anxiety and depression are identified as predictors of poorer surgical recovery, including lower patient-reported function, reduced satisfaction, and higher postoperative pain ResearchGate+2PMC+2BioMed Central+2.
Functional decline: Depressed patients self-report worse functional and satisfaction outcomes at both baseline and 2‑year follow-up in procedures like hip arthroscopy Bioscientifica+9PMC+9ScienceDirect+9.
Adherence & complications: Depression and anxiety correlate with lower adherence to postoperative regimens, increased surgical complications, longer hospital stays, and higher morbidity/mortality PMCPubMed.
🔁 Biopsychosocial Mechanisms
Bidirectional pain–mental health link: Chronic pain and psychiatric distress share overlapping brain regions (e.g., medial prefrontal cortex, limbic system) and neurotransmitter pathways (serotonin, norepinephrine), amplifying each other in a feedback loop PMC.
Opioid-related risk: Use of opioids for pain management in orthopaedic trauma may exacerbate depressive symptoms and increase risk of dependency, potentially worsening recovery outcomes. Non‑opioid multimodal management is encouraged ResearchGate+4PMC+4PubMed+4.
🩺 Screening Tools & Interventions
Mental health assessments: Recommended tools include PHQ‑9 (depression), GAD‑7 (anxiety), and SF‑36 (quality of life/psychological distress) to help identify at-risk patients and guide interventions PubMed+4PMC+4Bohrium+4.
Multidisciplinary care models: Authors advocate for integrated perioperative strategies addressing both physical and mental health, including pre‑ and postoperative psychological support, to optimize patient outcomes BioMed Central+5PMC+5SciSpace+5.
📊 Quantitative Findings & Illustrative Data
While the review is narrative rather than meta‑analytic, representative findings include:
High psychiatric comorbidity, with up to 45% prevalence rates for anxiety/depression in trauma cohorts PMCPubMed.
Specific risk contexts: Patients undergoing traumatic limb amputations or with high psychological distress fare worse on functional and quality-of-life outcomes BioMed Central.
Adherence matters: Better adherence to postoperative care in geriatric hip fracture cohorts lowered anxiety/depression, resulting in fewer complications like DVT and joint stiffness PMC.
🧭 Summary Table
Domain | Findings |
Psychiatric Rates | Anxiety/depression up to ~45% among orthopaedic trauma patients |
Surgical Outcomes | Poorer pain control, lower function, reduced satisfaction, higher complications |
Mechanistic Pathways | Pain–depression bidirectional loop; opioid usage may exacerbate depression |
Screening & Tools | PHQ‑9, GAD‑7, SF‑36 panels help stratify risk pre- and post-surgery |
Care Recommendations | Multidisciplinary, integrated physical + psychological interventions |
✅ Clinical Implications
Screen early: Implement PHQ‑9 and GAD‑7 screening preoperatively to stratify risk and tailor care.
Integrate psychological support: Address psychiatric distress concomitant to surgical planning, especially in patients with known trauma, chronic pain, or prior mental health history.
Optimize pain management: Favor multimodal, non‑opioid approaches to minimize depression-related adverse effects.
Support adherence: Structured postoperative care programs can reduce psychiatric distress and support better recovery trajectories.
Comments