Screening for Depression
Many times when I work with my patients, they are not the happiest people. Some patients are in a lot of pain, some frustrated with their physical deficits. Although I explain to patients the course of treatment and estimated timeline for recovery, there are a few patients who cannot see the light at the end of the tunnel and are consistently pessimistic.
It is sometimes draining for me to see this, because I cannot make time go faster or skip to the part where my patient finally feels better. I can empathize with them, and often times I see these patients' moods improve simultaneously with their progress towards their goals -- whether it be less pain, more range of motion or any other improvement.
A new research article popped onto my Twitter feed last night and I found the subject to be particularly interesting, "Recovery From Depressive Symptoms Over the Course of Physical Therapy: A Prospective Cohort Study of Individuals With Work-Related, Orthopaedic Injuries and Symptoms of Depression." While I notice occasional symptoms of depression in some of my patients, I haven't researched the topic to fully understand the red flags for a patient who may be depressed.
But after seeing the title of this article, something clicked for me -- that patients experiencing orthopedic injuries would be more as risk for depression due to the pain and disability often associated with those injuries. It seems like common sense to me now, but sometimes these simple concepts are the farthest from my mind when I am in the middle of treating my patients. I think about the differences between a tendonitis or a bursitis, how to position my patient correctly for a mobilization or things of that nature.
Having recently transitioned from an inpatient acute setting to an outpatient orthopedic setting, I am constantly learning new things every day (and re-learning things I knew in school). As the article states, 25 to 50 percent of patients referred to physical therapy for orthopedic injuries suffer from symptoms of depression. I can only imagine the impact depression has on the course of physical therapy treatment. I need to remind myself to not focus so much on the structure or the body part but to also remember the whole patient. Sometimes the simplest things make the most difference in our care.
Aside from depression, there are many other symptoms physical therapists should watch for -- symptoms of abuse, for eating disorders, for other co-morbidities our patients may not have shared with other providers. How do you screen for these?
Wideman, T.H., Scott, W., Martel, M.O., & Sullivan, M.J.L. Recovery from depressive symptoms over the course of physical therapy: A prospective cohort study of individuals with work-related, orthopaedic injuries and symptoms of depression. J Orthop Sports Phys Ther, Epub 18 June 2012. doi:10.2519/jospt.2012.4182