Thank you very much. I'd like to thank my co-authors at the Rothman Orthopaedic Institute as well. These are our disclosures. So, major depressive disorder, or MDD, is a leading cause of disability worldwide. It affects 8% of adults in the United States. Interestingly, multiple studies have shown that there is a relationship between multiple skeletal injuries and depression symptoms. Studies have shown that there is a higher prevalence of depression with patients that have rotator cuff injuries, ACL tears, and muscular skeletal trauma. One study that seeks to further investigate this relationship was performed by Dr. Garcia and his fellow authors, and they investigated the relationship between depression symptoms and ACL tears. And what they found was that 42% of patients during the preoperative period had signs of depression that were consistent with MDD. They found that these patients had worse preoperative knee function and worse postoperative knee function, and they concluded that depression may be a modifiable risk factor for short-term outcomes. However, the relationship between depression symptoms and outcomes following shoulder stabilization is unknown at this time. And so, our primary aim of our study was, one, to determine what is the prevalence of depression symptoms amongst these patients that are undergoing shoulder stabilization, and then two, to see what is the relationship between depression symptoms and shoulder function both before and after stabilization. And so, we chose to enroll all adult patients that were indicated for primary shoulder stabilization. We excluded patients with rotator cuff pathology, with out of my vision procedures, with a history of psychological disorders, and patients with workman's compensation claims. We assessed preoperative shoulder function and depression scores using the WOSI for shoulder function and the QIDS for depression scores. A score of six or more on the QIDS is indicative of MDD. And so, based off this, we created two cohorts. The MDD cohort, which scored six or more, and the non-MDD cohort, which scored less than six. And then these cohorts were tracked from six weeks post-op to one year post-op. In total, 88 patients were enrolled, half of which scored high enough to be in the MDD cohort. So, 44 patients were in the MDD cohort, whereas 44 were in the non-MDD cohort. The average age was roughly 30. The study was predominantly males, and a little over half had chronic injuries that lasted for greater than six months and before treatment. As we can see from this graph, the MDD cohort, or the depressed group, had worse shoulder function at all time points. However, it was significantly worse at the preoperative time point and the one-year post-operative time point. Of note, patients had improvement in shoulder function throughout the entire study. When we looked at depression scores, we saw a similar pattern with the MDD group having worse depression scores throughout the entire study. This was expected for the preoperative period based off how we chose these groups, but it was interesting to note that they continued to have worse scores throughout the entire study. However, both groups had improvement in scores over time. Most interesting was the correlation between on-depression scores and shoulder function scores. So, what we found was that preoperative depression scores correlated with worse preoperative shoulder function and as well as worse one-year post-operative shoulder function and one-year post-operative on-depression scores, but worse preoperative shoulder function did not correlate with worse post-operative shoulder function. This relationship, or lack thereof, shows that the relationship that is between depression and shoulder function is not mediated by shoulder function, but instead is mediated by on-depression. So, a better way to clarify that is preoperative depression leads to preoperatively worse shoulder function, and then preoperative depression leads to worse post-operative depression, which in turn leads to worse post-operative shoulder function. In conclusion, 50% of patients in our cohort had signs of MDD diagnosis on preoperatively. 27% continued to show this at one-year post-op. Patients with preoperative MDD symptoms have, I'm thinking, worse preoperative shoulder functions and worse post-operative shoulder functions. And given this relationship, preoperative MDD symptoms are a potential risk factor for worse shoulder outcomes during the short-term period, and we believe that they should be at least screened for and addressed during the preoperative or perioperative time point. Thank you for your time.

Rothman Orthopaedic Institute

depression symptoms

shoulder function

shoulder stabilization surgery

preoperative depression symptoms