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depression on postoperative clinical outcomes in patients who had been followed for 2 years, using a multicenter hip arthroscopic surgery registry in the United States. The study included a Table 1. Evaluation Tools for Psychiatric or Premorbid Psychiatric Conditions According to Type of Mental Disorder Type of mental disorder Evaluation tool Anxiety BSI anxiety scale Hospital anxiety and depression scale Patient-reported outcomes measurement information system anxiety Hamilton anxiety scale Depression Beck depression inventory BSI depression scale Center for epidemiologic studies depression scale Hamilton depression scale Brief symptom rating scale EQ-5D quality of life Quality of life inventory PTSD Primary care PTSD screen for DSM-5 Clinician-administered PTSD scale for DSM-5 PTSD checklist for DSM-5 Activity of daily living Physical components summary score and mental components summary score as measured by the 12-item short form survey. Disabilities of the arm, shoulder and hand score BSI: brief symptom inventory, EQ-5D: EuroQoL five-dimensional instrument, PTSD: posttraumatic stress syndrome, DSM: diagnostic and statistical manual of mental disorders. Major mental illness Capacity to understand and make decisions Defense mechanism Suicide risk Compliance Substance addiction 6 Considerations Fig. 1. Diagram for six considerations in preoperative psychiatric evaluation. 158 Yoo et al. Mental Disorder in Orthopedic Patients Clinics in Orthopedic Surgery • Vol. 14, No. 2, 2022 • www.ecios.org total of 781 patients with a mean age of 35.8 years (standard deviation, 13 years) and 37% were women. Patients with symptoms of depression scored significantly lower on the initial 12-item international hip outcome tool (iHOT-12) and a visual analog scale (VAS) and on the 2-year followup iHOT-12, VAS, and rating scale of surgical satisfaction. The authors argued that the surgeon should identify depressive symptoms before surgery and be aware that they may affect the clinical outcome after surgery. Garcia et al.16) analyzed the effects of depression on clinical outcomes after anterior cruciate ligament reconstruction and reported that depressed patients had significantly lower self-reported functional scores at baseline and 1 year postoperatively. They also argued that interaction and counseling between the physical therapist and the patient may occur during the course of rehabilitation. Rosenberger et al.17) argued that recovery and return to a desired level of activity after surgery can be influenced by environmental, personal, and psychological factors. Tjong et al.18) also found that self-motivation, optimism, strong social support, and appropriate goal setting positively affected return to sports after hip arthroscopic surgery for FAI. ARTHROPLASTIC SURGERY IN PATIENTS WITH MENTAL DISORDERS Stone et al.11) analyzed the effects of psychiatric diagnosis and psychotropic medication on clinical outcomes after primary total joint arthroplasty (TJA). Among 3,020 patients who underwent primary TJA from 2017 to 2018, 32.3% had a preoperative psychiatric diagnosis, and these patients were more likely to experience postoperative emergency room visits and discharge to a skilled nursing facility than patients without a psychiatric diagnosis. Also, patients with psychotropic medication had a higher rate of skilled nursing facility discharge. According to Halawi et al.’s study19) on the psychological distress of patients who underwent primary TJA, postoperative psychological distress was high when they had preoperative depression, lived alone, smoked, or had little education, and this stress increased the length of hospital stay. In a study of clinical outcomes of patients undergoing total hip arthroplasty (THA), Schwartz el al.20) also showed that preoperative depression was associated with postoperative medical complications, prosthetic joint infection, readmission, allogenic blood transfusion, nonhome discharge, less improvement in pain, decreased satisfaction, and high cost of care. In addition, patients with depression who did not receive psychotherapy were more likely to be discharged to an inpatient rehabilitation facility, require two or more postoperative narcotic prescriptions, continue narcotic requirements, and undergo revision at postoperative 1 and 3 years. Wilson et al.21) selected 111,838 patients undergoing THA from the Truven MarketScan database and reported on postoperative new-onset depression. They reported that patients with new-onset depression at 1 year postoperatively was 2,517 (2.25%) and risk factors were sex, opioid use, higher Elixhauser comorbidity index, anxiety disorder, drug- or alcohol-use disorder, and smoking before surgery. In addition, new-onset depression increased the risk of postoperative prosthetic joint infection, aseptic revision surgery, periprosthetic fracture, and non-home discharge. MENTAL DISORDERS IN TRAUMA PATIENTS Musculoskeletal injury can affect mental and social health depending on the severity of symptoms and the magnitude of self-reported activity limitations.22) Patients can experience both stress and distress, as well as unhelpful cognitive bias about pain, such as fear of painful movement during recovery. They can experience sadness, anger, guilt, shock, and denial. The American Academy of Orthopedic
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