Abstract
ObjectivesThis prospective observational study investigated whether self-reported psychological distress and alcohol use problems of surgical patients change between preoperative baseline assessment and postoperative 6-month follow-up examination. Patients with preoperative interest in psychotherapy were compared with patients without interest in psychotherapy.MethodsA total of 1,157 consecutive patients from various surgical fields completed a set of psychiatric questionnaires preoperatively and at 6 months postoperatively, including Patient Health Questionnaire-4 (PHQ-4), Brief Symptom Inventory (BSI), Center for Epidemiologic Studies Depression Scale (CES-D), World Health Organization 5-item Well-Being Index (WHO-5), and Alcohol Use Disorder Identification Test (AUDIT). Additionally, patients were asked for their interest in psychotherapy. Repeated measure ANCOVA was used for primary data analysis.Results16.7% of the patients were interested in psychotherapy. Compared to uninterested patients, they showed consistently higher distress at both baseline and month 6 regarding all of the assessed psychological measures (p’s between <0.001 and 0.003). At 6-month follow-up, neither substantial changes over time nor large time x group interactions were found. Results of ANCOVA’s controlling for demographic variables were confirmed by analyses of frequencies of clinically significant distress.ConclusionIn surgical patients with interest in psychotherapy, there is a remarkable persistence of elevated self-reported general psychological distress, depression, anxiety, and alcohol use disorder symptoms over 6 months. This suggests high and chronic psychiatric comorbidity and a clear need for psychotherapeutic and psychiatric treatment rather than transient worries posed by facing surgery.
Highlights
Few studies have investigated psychological distress in surgical patients
In order to control for the differences in sociodemographic characteristics, the ANCOVAs analyzing the course of selfreported psychological distress include gender and partnership status as additional between-subject factors and age as a covariate; Table 3
+Number ranges for the specific variables from 1,145 to 1,157, from 189 to 193 and from 953 to 964 because of missing data. ++Data for ASA and surgical field are available for the implementation phase; numbers account to 715, 101
Summary
Few studies have investigated psychological distress in surgical patients. With the exception of two earlier large-scale investigations [1,2] research is mostly based on small samples, distinct surgical fields and specific psychological factors. O’Hara et al (1989) found in a large sample study that the rate of patients with clinically significant psychological distress was even higher 3 months after surgery than at the day before surgery [1]. Recent investigations of smaller samples and with follow-up times ranging from 3 days to 3 to 5 years show a differentiated picture: Some studies confirmed the increase of psychological distress [10,11], others found no significant change [12,13,14], a significant decrease [15,16,17,18], patterns of no significant change and decrease [19,20], or patterns of both increase and decrease [21,22]. Of surgical field or physical health, interest in psychotherapy was significantly associated with the intensity of self-reported symptoms of general psychological distress, depression, anxiety and substance use disorders. Only a prospective longitudinal investigation will provide data to clarify whether elevated symptoms remain stable over time or decrease after patients have overcome the hospital stay
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