Effect of Depressive Symptoms at Acute Stage on the Course of Disease Progression in Whiplash Patients

ABSTRACT

OBJECTIVE: To find out the effect of depressive symptoms at acute stage on the course of disease progression in whiplash patients. METHOD: Thirty-eight patients with neck pain after acute whiplash injury were enrolled. The patients were prospectively surveyed within 7 days after whiplash injury and followed up after discharge by telephone interview. Depressive symptoms, self-perceived disability from neck pain, and pain intensity were measured by Center for Epidemiological Studies-Depression Scale (CES-D), neck disability index (NDI), and visual analog scale (VAS), respectively. Depressive group was defined as CES-D scores more than 21. The correlation between duration of total treatment and CES-D score and other variables was investigated by calculating independent t-test, Pearson's correlation coefficient and linear regression analysis. RESULTS: The mean overall score of CES-D was 20.8+/-11.7 and 20 (52.6%) patients were classified as depressive group. Depressive group showed longer duration of total treatment (55.1+/-35.1 vs 38.9+/-16.4, p>0.05) and higher pain intensity after total treatment (37.0+/-21.3 vs 29.4+/-20.1, p>0.05) than non-depressive group, but statistical significance was not sufficient. Duration of total treatment was correlated with NDI score (gamma=0.454, p<0.01) and initial pain intensity (gamma=0.349, p<0.05), but not related with socio-demographic factors - age, gender, marital status - and CES-D score. CONCLUSION: Duration of total treatment was correlated with physical disability and initial pain intensity. Depressive symptoms at acute stage of whiplash injury was correlated with both of them. Depressive symptoms could affect the outcome of whiplash injury indirectly through pain intensity and physical disability.