Depression, Anxiety, and Post-Traumatic Stress Disorder Following Orthopedic War Injuries

Hysterical motility disorders during the First World War: cases from the orthopaedic department of the Red Cross Hospital in Zagreb

PURPOSE

This paper examines how Vladimir Ćepulić at the orthopaedic department of the Red Cross Hospital in Zagreb described, understood and treated hysterical motility disorders between 1915 and 1917.

METHODS

We analysed Ćepulić's article from 1919 on 107 cases of motility disorders among World War I veterans. Our analysis involved a formal examination of historical records, articles, and contemporary literature on conversion disorders, as well as a contextual analysis of Ćepulić's work.

RESULTS

Ćepulić's report is a rare record of patients with conversion disorder treated within an orthopaedic department during the First World War. It provides detailed descriptions and documentation including photographs. By subscribing to the hysterical aetiology of this disorder, Croatian orthopaedists employed a diverse range of treatments, such as hypnosis, suggestion, electricity, anaesthesia and surgery.

CONCLUSION

We have demonstrated that a significant number of patients with motility disorders of psychogenic origin were treated at the orthopaedic department of the Red Cross Hospital in Zagreb. The detailed descriptions left by our predecessors can be used to trace the epidemiology and evolution of these disorders over time, including complex conditions like conversion disorder.

Acute stress disorder in patients with accidental traumatic fractures: What can we do

AIM

To evaluate the potential influencing factors of acute stress disorder (ASD) in patients with accidental traumatic fractures to provide evidence for clinical nursing care.

DESIGN

A retrospective study.

METHODS

Patients with traumatic fractures treated in our hospital from 1 January 2020 to 30 November 2021 were included. The characteristics of ASD and no ASD patients were assessed.

RESULTS

A total of 468 patients with traumatic fractures were included, the incidence of ASD was 28.20%. Logistic regression analysis showed that age ≤50 years (OR2.918, 95% CI1.994 ~ 3.421), female (OR2.074, 95% CI1.489 ~ 3.375), AIS-ISS at admission ≥20 (OR3.981, 95% CI2.188 ~ 5.091), VAS at admission≥7 (OR2.804, 95% CI2.027 ~ 3.467), introverted personality (OR1.722, 95%CI1.314 ~ 2.432) and CD-RISC at admission≤60 (OR3.026, 95% CI2.338 ~ 4.769) were the risk factors of ASD in patients with traumatic fractures (all p < .05).

CONCLUSIONS

The development of ASD in patients with traumatic fractures is affected by multiple factors. Medical workers should take early and timely management and nursing measures for related risk factors to reduce the occurrence of ASD.

Systematic Review of the Association Between Trauma Severity and Postinjury Symptoms of Depression

BACKGROUND

Greater symptoms of depression are associated with greater symptom intensity during recovery from musculoskeletal injury. It is not clear that more severe trauma is associated with greater symptoms of depression as one might expect. The goal of this study was to systematically review the existing evidence regarding the association of Injury Severity Score (ISS) with symptoms of depression during recovery from musculoskeletal injury.

METHODS

Two independent reviewers used PubMed and Embase to identify studies that measured both ISS and symptoms of depression. Among the 17 studies satisfying inclusion criteria, 5 studies assessed the correlation of symptoms of depression and ISS on their continuum; 3 studies compared the mean of symptoms of depression for people above and below a specific ISS level; five compared mean ISS above and below a threshold level of symptoms of depression; and four compared dichotomized ISS and dichotomized depression. Four of the 17 evaluated factors associated with symptoms of depression in multivariable analysis.

RESULTS

In bivariate analysis, 12 of 17 studies (71%) found no association between ISS level and symptoms of depression. Three studies found a bivariate association that did not persist in multivariable analysis. Two studies reported slight associations in bivariate analysis, but did not perform multivariable analysis.

CONCLUSIONS

The knowledge that symptoms of depression are common during recovery, in combination with the finding of this review that they have little or no relationship with injury severity, directs clinicians to anticipate and address mental health during recovery from physical trauma of any severity.