Treatment and Prevention of Depression After Surgery for Hip Fracture in Older People: Randomized, Controlled Trials

Authors

  • Alistair Burns MD,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Sube Banerjee MD,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Julie Morris MSc,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Yvonne Woodward MSc,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Robert Baldwin MD,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Rebekah Proctor PhD,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Nicholas Tarrier PhD,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Neil Pendleton MD,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Deborah Sutherland RMN,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Glynne Andrew MD,

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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  • Mike Horan MD

    1. From the *Division of Psychiatry, Department of Clinical Psychology, Department of Geriatric Medicine, University of Manchester, Manchester, United Kingdom§Department of Mental Health and Aging, Institute of Psychiatry, London, United KingdomDepartment of Medical Statistics, Department of Clinical Psychology, Wythenshawe Hospital, Manchester, United Kingdom#Department of Orthopaedics, Northwest Wales National Health Service Trust, Bangor, United Kingdom.
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Address correspondence to Alistair Burns, MD, Professor of Old Age Psychiatry, University of Manchester, 2nd Floor, Education and Research Center, Wythenshawe Hospital, Manchester, UK M23 9LT. E-mail: alistair.burns@manchester.ac.uk

Abstract

OBJECTIVES: To evaluate the effect of a psychiatric intervention in treating depression (treatment study) and the effect of a psychological treatment in preventing depression (prevention study) after hip fracture in older people.

DESIGN: Two linked randomized, controlled trials.

SETTING: Orthopedic units in Manchester, England.

PARTICIPANTS: Two hundred ninety-three older people who had undergone surgery for a fractured hip: 121 in the treatment study and 172 in the prevention study.

MEASUREMENTS: The Geriatric Depression Scale and Hospital Anxiety and Depression Scale for mood, functional tests for mobility and pain measures.

RESULTS: There was a slight reduction in depressive symptoms in the active arm of the treatment study. In the prevention study, there was no significant difference in incident depression between the psychological intervention and treatment as usual. There were no differences in the functional and pain outcomes.

CONCLUSION: The results from these two randomized, controlled trials show that, after hip fracture surgery, no statistically significant benefits can be achieved from a psychiatric intervention in people who are depressed or a psychological intervention to prevent the onset of depression.

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