Correlation of anxiety and depression with ankle function in chronic ankle instability patients and analysis of risk factors

Abstract

BACKGROUND

Psychological comorbidities, such as anxiety and depression, in patients with chronic ankle instability (CAI) may impede ankle function improvement, although the precise nature of this association warrants further investigation.

AIM

To analyze the correlation of anxiety and depression with ankle function in patients with CAI and discussing the risk factors.

METHODS

This study included 116 patients with CAI, who were admitted to our hospital from July 2022 to July 2024. Anxiety and depression states of patients were assessed with the self-rating anxiety scale (SAS) and self-rating depression scale (SDS), respectively, and their ankle joint function was assessed with the ankle-hindfoot function score of the American Orthopedic Foot and Ankle Society. Further, the ankle function of patients with CAI with different anxiety and depression states was discussed. Furthermore, the Pearson correlation coefficient was used to analyze the correlation of anxiety and depression with ankle joint function in such patients. Univariate and multivariate analyses were conducted to investigate the factors affecting ankle joint function in patients with CAI.

RESULTS

Among the 116 patients with CAI, 97, 13, 5, and 1 cases demonstrated none, mild, moderate, and severe anxiety, whereas 95, 15, 6, and 0 cases showed none, mild, moderate, and severe depression, respectively. The average ankle joint function score was 74.82 ± 6.93 points. The ankle joint function in patients with CAI presented a significant downward tendency as the degree of anxiety and depression increased. Correlation analysis revealed that both the SAS and SDS scores of patients with CAI were significantly negatively correlated with the ankle joint function score. Univariate and multivariate analyses indicated that the risk factors affecting patients’ ankle joint function included early functional rehabilitation, visual analog scale, and SDS.

CONCLUSION

A substantial number of patients with CAI suffer from anxiety and depression, and these negative emotions, to a certain extent, harm the smooth rehabilitation of ankle joint function.

Keywords: Chronic ankle instability; Anxiety and depression; Ankle function; Correlation analysis; Risk factors

Core Tip: The incidence of chronic ankle instability (CAI) reaches up to 53%, with nearly half of affected patients reporting negative emotions such as anxiety and depression. These psychological factors have negatively affected both treatment efficacy and functional recovery of the ankle. This study involved 116 patients with CAI and revealed that approximately 20.0% demonstrated varying severity of anxiety and depressive symptoms. Statistical analysis revealed a significant inverse correlation between the severity of patients’ anxiety/depression symptoms and their ankle functional outcomes. The study further determined three independent risk factors impairing ankle functional recovery: (1) Inadequate early functional exercise; (2) Increased pain levels as measured by the visual analog scale; and (3) Higher scores on the self-rating depression scale. These results indicate that clinical management should incorporate comprehensive psychological assessment and targeted interventions to optimize functional outcomes. Further, implementing early rehabilitation exercises and effective pain management strategies may help mitigate psychological distress while facilitating ankle function restoration.