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The effect of post-injury depression on return to pre-injury function: a prospective cohort study

Published online by Cambridge University Press:  02 March 2009

T. S. Richmond*
School of Nursing, Biobehavioral and Health Sciences Division, University of Pennsylvania, Philadelphia, PA, USA
J. D. Amsterdam
School of Medicine, Depression Research Unit, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
W. Guo
School of Medicine, Department of Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA, USA
T. Ackerson
School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
V. Gracias
School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
K. M. Robinson
School of Medicine, Department of Physical Medicine and Rehabilitation, University of Pennsylvania, Philadelphia, PA, USA
J. E. Hollander
School of Medicine, Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
*Address for correspondence: T. S. Richmond, Ph.D., CRNP, Associate Professor, University of Pennsylvania, School of Nursing, Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104, USA. (Email:



Millions of people seek emergency department (ED) care for injuries each year, the majority for minor injuries. Little is known about the effect of psychiatric co-morbid disorders that emerge after minor injury on functional recovery. This study examined the effect of post-injury depression on return to pre-injury levels of function.


This was a longitudinal cohort study with follow-up at 3, 6 and 12 months post-injury: 275 adults were randomly selected from those presenting to the ED with minor injury; 248 were retained over the post-injury year. Function was measured with the Functional Status Questionnaire (FSQ). Psychiatric disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR disorders (SCID).


During the post-injury year, 18.1% [95% confidence interval (CI) 13.3–22.9] were diagnosed with depression. Adjusting for clinical and demographic covariates, the depressed group was less likely to return to pre-injury levels of activities of daily living [odds ratio (OR) 8.37, 95% CI 3.78–18.53] and instrumental activities of daily living (OR 3.25, 95% CI 1.44–7.31), less likely to return to pre-injury work status (OR 2.37, 95% CI 1.04–5.38), and more likely to spend days in bed because of health (OR 2.41, 95% CI 1.15–5.07).


Depression was the most frequent psychiatric diagnosis in the year after minor injury requiring emergency care. Individuals with depression did not return to pre-injury levels of function during the post-injury year.

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Copyright © 2009 Cambridge University Press

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