A systematic literature review and narrative synthesis on the risk factors for developing affective disorders in open lower-limb fracture patients

BACKGROUND: Despite the advancements made in the management of the physical complications of open lower-limb fractures, few studies have been performed which investigate the association of such injuries with affective disorders. The complications resulting from this injury may result in significant psychological distress. AIM: To evaluate the risk factors associated with the development of affective disorders, in patients with open lower-limb fractures. METHODS: A systematic review protocol was registered with PROSPERO and reported in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses. A comprehensive literature search was performed to gather relevant papers. Two independent reviewers screened titles and abstracts according to the inclusion and exclusion criteria. RESULTS: 2488 were screened according to the inclusion and exclusion criteria resulting in seven articles eligible for inclusion. Of the seven articles, two assessed for PTSD, one assessed for depression and PTSD concurrently, two assessed for anxiety and depression concurrently, and two assessed for psychological distress. With the exception of two studies, open lower limb fracture patients were included with other lower-limb injuries in their analysis. Furthermore, not all variables were available in all included studies. Risk factors identified included post-operative pain, mechanism and severity of injury, age of patient, social support and social deprivation. CONCLUSIONS: Further studies are required within this area. However, addressing risk factors such as pain management, poor social support and inappropriate coping mechanisms, may reduce the incidence of affective disorders by equipping patients with necessary psychosocial resources.