Psychological Distress Among Patients of an Orthopaedic Out Patient Clinic: Study from a Low Income Country

Abstract

In high income countries depression is common among general trauma patients and is associated with a poor outcome. In the absence of previous reports from a developing country we evaluated the relationship of psychological distress to physical injury, musculoskeletal complaints, and social factors in Pakistan.

Methods:

One thousand and fourteen patients were recruited from a busy orthopaedic outpatient clinic at a general hospital in Karachi (90.5% response rate). Research assistants administered the Self Rating Questionnaire (SRQ) to measure psychological distress, the Oslo social support questionnaire, and the Brief Disability Questionnaire (BDQ). The surgeons documented the diagnosis and, if appropriate, rated symptoms as medically unexplained.

Results:

An SRQ score of 9 or more, which indicates probable depressive disorder, occurred in 45.6% of men & 76.1% of women. A high SRQ score was associated with female sex, divorced, separated or widowed status, little or no education, low income and little social support. Even after these were controlled for there was a significantly higher SRQ score in patients with arthritis, backache/prolapsed intervertebral disc, major fracture and other bone pathology. Overall there was no difference in SRQ score between patients with medically explained (by trauma or organic disease) or unexplained symptoms.

Conclusions:

Depressive disorder appears to be very common in orthopaedic out patients in this low income country and both social circumstances and nature of bone pathology are associated with such depression. Treatment should address this extreme psychological distress.