Do depression and anxiety profiles over time predict persistent post-surgical pain? A study in cardiac surgery patients.

Abstract

Rates of depression and anxiety in cardiac surgery patients are higher than in the general population. The development of persistent post-surgical pain (PPSP) in this population is also concerning. The objectives of this study were to (1) identify anxiety and depression trajectories of cardiac surgery patients over a 2-year period; (2) examine demographic and clinical characteristics associated with trajectory memberships and (3) determine if anxiety and/or depression trajectories predict PPSP. A total of 1071 patients completed questionnaires before cardiac surgery and 7days, 3, 6, 12 and 24months thereafter. Models were run using growth mixture modelling. Both anxiety and depression models yielded a 3-trajectory solution. A minority of patients (<10%) had unremitted major depression, almost one-third of patients had remitted minor depression and the remaining patients had no depression over the 2-year period. <10% of patients had unremitted elevated anxiety, almost 40% of patients had unremitted mild anxiety symptoms, whereas half of patients did not experience anxiety over the same time period. Patients with unremitted elevated anxiety were more likely to report PPSP; the association between depression and PPSP was not significant. The results' novelty lies in the identification of a homogeneous patient subgroup presenting with unremitted elevated anxiety which predicted the presence of PPSP up to 2years following cardiac surgery. Unlike anxiety, depression subgroups were not predictive of PPSP status. This article presents the relationship between anxiety and depression profiles over 2years in cardiac surgery patients and persistent post-surgical pain. These results suggest the importance of evaluating how early identification and treatment of high-risk patients could prevent PPSP. These results provide potential detection and prevention avenues of chronic pain for high-risk patients based on their anxiety trajectory.