The Effect of Anxiety and Depression on Outcomes of Idiopathic Adhesive Capsulitis

Introduction: Anxiety and depression are known comorbidities of adhesive capsulitis (AC); however, the impact of mental health disorders on treatment strategies and clinical outcomes remains underexplored. The purpose of this study was to examine 2-year outcomes among patients with AC with and without anxiety/depression. A secondary aim was to assess if pharmacotherapy or psychotherapy improved AC outcomes among those with anxiety/depression. Methods: Retrospective review of the PearlDiver national-claims database was performed (2010-2023). Patients were grouped by whether they had a diagnosis of anxiety or depression within the year before their first AC diagnosis. The anxiety/depression group was propensity score matched (PSM) 1:1 to the no-anxiety/depression group on demographics/comorbidities. Outcomes were compared between the matched cohorts. Multivariate linear and logistic regression were performed to assess anxiety/depression as a predictor of 2-year outcomes after matching. Results: Of the 1,021,051 patients with idiopathic-AC, 17.1% had a diagnosis of anxiety/depression within the year prior. After PSM, patients with anxiety/depression were 21% more likely to receive a steroid injection (odds ratio [OR] 1.21, p < 0.001), 29% more likely to have prolonged opioid use (OR 1.29, p < 0.001), and 28% more likely to report persistent shoulder pain (OR 1.28, p < 0.001) at 2 years postdiagnosis. Within the anxiety/depression cohort, 62.3% were prescribed antidepressants, while only 14.7% used psychotherapy. Both antidepressant and psychotherapy use were associated with greater risk of adverse outcomes; however, psychotherapy showed decreased rates of prolonged opioid use at 2 years postdiagnosis. Conclusion: Preexisting anxiety and depression were associated with increased rates of adverse outcomes among patients with AC up to 2 years after diagnosis. Antidepressant medication and psychotherapy did not confer significant improvements in AC outcomes overall, although psychotherapy was associated with reduced prolonged opioid use. These findings may aid in patient expectation setting. Further research is warranted to evaluate whether a multidisciplinary approach to managing AC in patients with concurrent mental health disorders improves outcomes. Level of Evidence: Level III < prognostic 2. See Instructions for Authors for a complete description of levels of evidence.