Are Attention Deficit Disorder, Depression, and Suicide More Common in Patients with Perthes Disease?

By Chad Price, MD and Harry Kim, MD


The researchers in Sweden found that the prevalence of attention deficit hyperactivity disorder (ADHD), depression, and suicide was 2.5%, 3.7%, and 3.9% in people with Perthes, respectively, in their study published in the scientific journal Acta Orthopaedica http://www.ncbi.nlm.nih.gov/pubmed/25036717.  In comparison to the general population, people with Perthes were 50% more likely to have ADHD, 30% more likely to become depressed and almost three times more likely to commit suicide as adults. This is alarming but important information, so doctors and parents can watch for early warning signs of depression. Early treatment may help prevent depression from reaching the more serious stage of attempted suicide.

The authors of the study suggested that hyperactivity may contribute to repeated injury to the hip that may be a possible cause of Perthes. Also, psychological stress from chronic pain and limited physical activities due to Perthes later in life may increase the risk of depression. Another possibility is that the Attention Deficit Disorders evolve into depression later in life. However, there were no clear reasons why these conditions are linked to Perthes except to serve as a warning for parents and
patients that have been diagnosed with this condition. Simple measures in later life may help stem depression. For example, an article in the New York Times summarized the importance of exercise to decrease the risk of depression in adults. Perhaps patients who have had Perthes are not finding exercise activities that meet their needs.

http://well.blogs.nytimes.com/2014/10/01/how-exercise-may-protect-against-depression/?_php=true&_type=blogs&_r=0

Another finding was that heart attacks were 20% more common in patients with Perthes. The connection between Perthes and heart attack is not clear. One theory is that Perthes is caused by clotting of the blood vessels of the hips which may also increase the risk for clotting of the coronary arteries later in life. So, it may be important for patients with Perthes to do all they can to decrease their own risks for heart attacks including regular medical evaluations as adults.

This study raises important concerns for patients diagnosed with Perthes disease to act on, later in life. Identifying associated conditions may help develop better treatments and better understanding of problems faced in adulthood by some patients who had Perthes disease in childhood. However, there is much more to be learned, and the International Perthes Study Group is dedicated to finding answers to, many questions about Perthes through collaborative work of many physicians who care about the patients with Perthes.