Relative Prevalence of Anxiety and Depression in Patients With Upper Extremity Conditions.

PURPOSE: Prior research regarding the impact of mental health on upper extremity musculoskeletal function and recovery has frequently grouped catastrophizing, anxiety, and depression. This study was designed to define the relative prevalence of heightened anxiety versus depressive symptoms among a patient population seeking upper extremity care and to determine if those prevalences varied according to the symptomatic condition.

METHODS

All adult patients presenting to a tertiary upper extremity orthopedic center between June 1, 2016 and November 30, 2016 (n = 3,315) completed the Patient-Reported Outcomes Measurement Information System (PROMIS) Anxiety and Depression Computer Adaptive Tests. Descriptive statistics and multivariable linear regression assessed differences in average PROMIS scores between demographic and diagnostic groups. Patients were also analyzed according to crossing thresholds for heightened anxiety and depression scores based on established linkage tables with the Generalized Anxiety Disorder 7 and Patient Health Questionnaire-9 Depression scales, respectively. Pearson chi-square analysis and binary logistic regression were performed to determine if the proportion of patients crossing these thresholds varied according to the primary symptomatic condition while accounting for patient age, sex, and race.

RESULTS

African American patients and those with carpal tunnel syndrome, trapeziometacarpal arthritis, or shoulder conditions reported significantly higher PROMIS Anxiety scores. Higher PROMIS Depression scores varied only by diagnosis. Seventeen percent of patients exceeded the Anxiety symptoms score threshold and 10% of patients exceeded the Depression symptom threshold. In logistic regression modeling, the likelihood of exceeding the Anxiety threshold varied by diagnosis and was increased in African American patients and females. African American race was associated with exceeding the Depression threshold while accounting for sex and diagnosis.

CONCLUSIONS

Patients with upper extremity conditions more frequently report heightened anxiety than heightened depression. Patient race and diagnosis are independent predictors of anxiety among patients seeking care for upper extremity conditions.

TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic II.