Systematic review of 28 studies: anxiety and depression decline within 12 months after upper limb fracture

A systematic review and meta-analysis published in BMC Musculoskeletal Disorders examined how psychological distress changes during the first 12 months after an upper limb fracture. The team led by Michael Mansfield searched published and unpublished literature databases up to 25 August 2026 and included 28 studies with 5,638 people biomedcentral.comBMC Musculoskeletal Disordersbiomedcentral.comOpen source ↗. Upper limb fractures cause substantial disability and loss of independence, creating a growing burden in an ageing population.

Depression and anxiety scores

The authors compared scores from early recovery (two to six weeks) with longer-term follow-up of up to 12 months. Depression decreased significantly: standardised mean difference (SMD) 0.65, 95% confidence interval (CI) 0.43–0.86, N = 2,230. Anxiety also decreased: SMD 0.51, 95% CI 0.43–0.59, N = 1,229.

The changes are described at a population level. The authors note that psychological distress was reported after upper limb fracture, and that scores generally decreased over the first year.

Fear of movement and pain catastrophising

Kinesiophobia scores were lower at six to 12 months than at the initial fracture assessment: mean difference (MD) 8.32, 95% CI 7.26–9.38, N = 1,072 biomedcentral.comBMC Musculoskeletal Disordersbiomedcentral.comOpen source ↗. Pain catastrophising scores were also lower: MD 2.05, 95% CI 1.66–2.43, N = 1,803. For pain catastrophising, the difference in effect estimates between shorter- and longer-term follow-up was not statistically significant (p = 0.26). According to the authors, kinesiophobia and pain catastrophising scores did not reach clinically important levels.

Quality of evidence and clinical conclusions

Using the Downs and Black appraisal tool, the reviewers rated overall methodological quality as moderate. Common limitations were inadequate adjustment for confounding (24 studies) and limited accounting for loss to follow-up (26 studies).

The authors state that further research is needed to determine the prevalence and trajectories of clinically important distress and to identify individuals at greatest risk. They advise clinicians to remain alert to symptoms of anxiety, depression, fear of movement and fear of falling, particularly where recovery is delayed, and to consider further assessment or referral where clinically indicated. In their assessment, current evidence is insufficient to recommend universal screening or a specific psychological intervention.