The psychological impact of long bone fractures in KwaZulu-Natal, South Africa: A cross-sectional study


Background: Long bone fractures are known to cause a decline in quality of life due to loss of physical functioning. Loss of independence due to loss or decline of physical functioning can also cause poorer psychological health. There is limited data on depression among orthopaedic patients in South Africa.
Methods: The validated Patient Health Questionnaire-9 depression scale was used to establish patient reported outcomes. The Chisquare or Fishers exact test was used where appropriate to compare the various psychological variables and the impact from upper and lower extremity sites. The Kruskal Wallis test was used to test differences in the overall depression score between subgroups. Univariate and multivariate linear regression was used to assess the relationship between variables of interest and the overall depression score, while adjusting for age and gender.
Results: A total of 821 research participants completed the questionnaire. The overall depression score in patients with a fracture ranged from 0 to 23 with a mean of 8.26 and a standard deviation of 4.76. The majority of participants (37.64%) had depression scores ranging from 5 to 9 which is associated with mild depression.



PlumX Metrics


Download data is not yet available.


Williams LJ, Berk M, Henry MJ, Stuart AL, Brennan SL, Jacka FN, et al. Depression following fracture in women: a study of age-matched cohorts. BMJ open. 2014;4(2):e004226. doi: 10.1136/bmjopen-2013-004226.

Ross C, Juraskova I, Lee H, Parkitny L, Stanton TR, Moseley GL, et al. Psychological Distress Mediates the Relationship Between Pain and Disability in Hand or Wrist Fractures. Journal of Pain. 2015;16(9):836-43.

Clark PM, Ellis BM. A public health approach to musculoskeletal health. Best practice & research Clinical rheumatology. 2014;28(3):517-32.

Park S, Lee Y, Youn T, Kim BS, Park JI, Kim H, et al. Association between level of suicide risk, characteristics of suicide attempts, and mental disorders among suicide attempters. BMC public health. 2018;18(1).

Kellezi B, Coupland C, Morriss R, Beckett K, Joseph S, Barnes J, et al. The impact of psychological factors on recovery from injury: a multicentre cohort study. Social psychiatry and psychiatric epidemiology. 2017;52(7):855-66.

Kendrick, Baker D, Hill R, Beckett T, Coupland K, Kellezi C, et al. Early risk factors for depression, anxiety and post-traumatic distress after hospital admission for unintentional injury: Multicentre cohort study. PSR Journal of Psychosomatic Research. 2018;112:15-24.

Wu H, Zhang F, Cheng W, Lin Y, Wang Q. Factors Related to Acute Anxiety and Depression in Inpatients with Accidental Orthopedic Injuries. Shanghai archives of psychiatry. 2017;29(2):77-84.

Jain R, Rishi R, Sharma B, Kiyawat V. Role of depression and its associating factors in indoor orthopaedic patients. Asian J Med Sci Asian Journal of Medical Sciences. 2015;6(6):70-6.

Fulde GWO. Emergency medicine : the principles of practice. Sydney; New York: Churchill Livingstone/Elsevier; 2004.

Dibbern KN, Willey MC, Phisitkul P, Glass NA, Marsh JL, Anderson DD. Fracture severity predicts OA risk following intra-articular fractures. YJOCA Osteoarthritis and Cartilage: Supplement 1. 2017;25:S109-S10.

Mendonça TM, Silva CH, Canto RS, Morales NM, Pinto RM, Morales RR. Evaluation of the health-related quality of life in elderly patients according to the type of hip fracture: femoral neck or trochanteric. Clinics (Sao Paulo, Brazil). 2008;63(5):607-12.

Lowry J. Bone Regeneration and Repair: Biology and Clinical Applications Bone Regeneration and Repair: Biology and Clinical Applications. Humana (New Jersey), The Annals of The Royal College of Surgeons of England. 2006;88(3):334.

Braimah RO, Ukpong DI, Ndukwe KC, Akinyoola AL. Comparative study of anxiety and depression following maxillofacial and orthopedic injuries. Study from a Nigerian University Teaching Hospital. CRE2 Clinical and Experimental Dental Research. 2017;3(6):215-9.

Forsberg A, Söderberg S, Engström Å. People's experiences of suffering a lower limb fracture and undergoing surgery. JOCN Journal of Clinical Nursing. 2014;23(1-2):191-200.

Beck A, Crain AL, Solberg LI, Unützer J, Glasgow RE, Maciosek MV, et al. Severity of depression and magnitude of productivity loss. Annals of family medicine. 2011;9(4):305-311.

Deckers L. Motivation : biological, psychological, and environmental. 2018.

Russell V. Putting Stress in Life : Hans Selye and the Making of Stress Theory. Social Studies of Science. 1999;29(3):391-410.

Aitken LM, Chaboyer W, Jeffrey C, Martin B, Whitty JA, Schuetz M, et al. Indicators of injury recovery identified by patients, family members and clinicians. Injury. 2016;47(12):2655-63.

Shulman BS, Liporace FA, Davidovitch RI, Karia R, Egol KA. Sleep disturbance after fracture is related to emotional well-being rather than functional result. Journal of orthopaedic trauma. 2015;29(3):146-50.

Westerterp-Plantenga MS. Sleep, circadian rhythm and body weight: parallel developments. The Proceedings of the Nutrition Society. 2016;75(4):431-9.

Sanna L, Girardi P, Stuart AL, Pasco JA, Kotowicz MA, Berk M, et al. Suicidal ideation and physical illness: Does the link lie with depression? J Affective Disord Journal of Affective Disorders. 2014;152-154(1):422-6.

Casale M, Boyes M, Pantelic M, Toska E, Cluver L. Suicidal thoughts and behaviour among South African adolescents living with HIV: Can social support buffer the impact of stigma? JAD Journal of Affective Disorders. 2019;245:82-90.

Boon SD. Frank W. Schneider, Jamie A. Gruman, and Larry M. Coutts (Eds.) Applied Social Psychology: Understanding and Addressing Social and Practical Problems. Canadian psychology Psychologie canadienne. 2005;46:251.

Barone DF, Hersen M, Van Hasselt VB. Advanced personality. New York: Plenum Press; 1998.

Brown JD. The self. Boston, Mass.: McGraw-Hill; 1998.

Sluys KP, Shults J, Richmond TS. Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries. JINJ Injury. 2016;47(4):824-31.

Original Articles
long bone fracture, depression, psychological impact
  • Abstract views: 4201

  • PDF: 190
  • HTML: 0
How to Cite
Singaram, S., & Naidoo, M. (2020). The psychological impact of long bone fractures in KwaZulu-Natal, South Africa: A cross-sectional study. Journal of Public Health in Africa, 11(2).