Analysis Of Depression-related Factors In Patients With Skull Defect And The Effect Of Early Cranioplasty On Depression

Objective:Clinically,trephined syndrome may occur in patients with cranial defect,and in severe cases,it may affect the quality of life of patients.This study explored the related influencing factors of the formation of depressive disorder in patients with cranial defect,and explored the influence of early cranioplasty on patients’ depression.Methods:Eighty patients with skull defect in our hospital were selected.HAMD scale was used to evaluate the depression scores of the patients before surgery.According to the scores,the patients were divided into depression group and non-depression group,and the related influencing factors of depression in the patients with skull defect were screened by logistic regression analysis.The cranial defect patients with depression were divided into early group(cranial defect time ≤4 months)and late group(cranial defect time > 4 months).After cranioplasty,the HAMD scale was evaluated again 1 week and 3 months after surgery,respectively.The changes of HAMD score and the improvement rate of depression were compared between the early group and the late group before surgery,1 week after surgery and 3 months after surgery,to explore the influence of early cranioplasty on patients’ depression.Results:Univariate analysis shows that:GCS score(P < 0.001),personality(P=0.028),family economic status(P=0.042),skull defect time(P=0.002),skull defect area(P=0.001),frontal lobe injury(P=0.016),limb movement disorder(P=0.01)were correlated with skull defect depression disorder.Multivariate regression analysis showed that cranial defect area >100cm ~2(P=0.01),limb movement disorder(P=0.027),low GCS score(P=0.002)were independent risk factors for depression in cranial defect patients.The HAMD scale was evaluated again after cranioplasty in the two groups.The HAMD scores of patients in the early group were(25.00±4.226),(23.07±3.955),(17.20±3.895)before surgery,1 week after surgery and 3 months after surgery,respectively.HAMD scores of patients in the late group were(26.74±4.931),(24.53±5.179)and(21.05±4.636)before surgery,1 week after surgery and 3months after surgery,respectively.The mean HAMD scores of patients showed a downward trend with the change of time after cranioplasty,and the difference was statistically significant(P < 0.001).There were interaction effects between the early group and the late group as well as at each time point before and after cranioplasty.With the change of time after cranioplasty,THE HAMD score of the early group decreased more than that of the late group,and the difference was statistically significant(P= 0.001).The analysis of depression improvement rate of patients after cranioplasty showed that 1 week after cranioplasty,the depression improvement rate of patients in the early group and the late group was 13.3% and 5.3%,respectively,with no statistical difference(P > 0.05).Depression scores in both groups improved 3months after surgery compared with before surgery,and the improvement rate of depression in the early group was significantly higher than that in the late group,the difference being statistically significant(60.0% vs 21.1%,P=0.034).Conclusion:Clinically,it is necessary to pay special attention to the depression of cranial defect patients with severe primary brain injury,large cranial defect area and limb movement disorder,and take targeted measures in the diagnosis and treatment process.Cranial repair has positive effect on depressive disorder in patients with cranial defect,and early repair is beneficial to long-term improvement of depression in patients with cranial defect.