Review Question - QID 220379

A 50-year-old male laborer with a past medical history of major depressive disorder, anxiety and diabetes falls from a ladder, sustaining a right open tibial shaft fracture and an associated small subdural hematoma. Physical examination reveals a ten centimeter open wound over the fracture site. He is appropriately treated for his open fracture in the Emergency Department and admitted to the intensive care unit for neuromonitoring. Eventually, his fracture is definitively fixed in the operating room with irrigation and debridement, followed by tibial intramedullary nailing. Which of the following factors contributes to the development of depressive symptoms in this orthopedic trauma patient?