Postoperative Psychosocial Adjustment Research Articles

Depression after stoma surgery: a systematic review and meta-analysis

BackgroundDepression is the leading cause of global disability and can develop following the change in body image and functional capacity associated with stoma surgery. However, reported prevalence across the literature is unknown. Accordingly, we performed a systematic review and meta-analysis aiming to characterise depressive symptoms after stoma surgery and potential predictive factors.MethodsPubMed/MEDLINE, Embase, CINAHL and Cochrane Library were searched from respective database inception to 6 March 2023 for studies reporting rates of depressive symptoms after stoma surgery. Risk of bias was assessed using the Downs and Black checklist for non-randomised studies of interventions (NRSIs), and Cochrane RoB2 tool for randomised controlled trials (RCTs). Meta-analysis incorporated meta-regressions and a random-effects model. Registration: PROSPERO, CRD42021262345.ResultsFrom 5,742 records, 68 studies were included. According to Downs and Black checklist, the 65 NRSIs were of low to moderate methodological quality. According to Cochrane RoB2, the three RCTs ranged from low risk of bias to some concerns of bias. Thirty-eight studies reported rates of depressive symptoms after stoma surgery as a proportion of the respective study populations, and from these, the median rate across all timepoints was 42.9% 42.9% (IQR: 24.2–58.9%). Pooled scores for respective validated depression measures (Hospital Anxiety and Depression Score (HADS), Beck Depression Inventory (BDI), and Patient Health Questionnaire-9 (PHQ-9)) across studies reporting those scores were below clinical thresholds for major depressive disorder according to severity criteria of the respective scores. In the three studies that used the HADS to compare non-stoma versus stoma surgical populations, depressive symptoms were 58% less frequent in non-stoma populations. Region (Asia–Pacific; Europe; Middle East/Africa; North America) was significantly associated with postoperative depressive symptoms (p = 0.002), whereas age (p = 0.592) and sex (p = 0.069) were not.ConclusionsDepressive symptoms occur in almost half of stoma surgery patients, which is higher than the general population, and many inflammatory bowel disease and colorectal cancer populations outlined in the literature. However, validated measures suggest this is mostly at a level of clinical severity below major depressive disorder. Stoma patient outcomes and postoperative psychosocial adjustment may be enhanced by increased psychological evaluation and care in the perioperative period.

Anterior temporal encephaloceles: Elusive, important, and rewarding to treat.

To investigate the etiology and longitudinal clinical, neuropsychological, psychosocial, and surgical outcome profile of patients with medication refractory epilepsy and temporal encephaloceles with a view to highlight diagnostic clues and management strategies. The comprehensive epilepsy program databases at two surgical epilepsy centers from January 2000 to October 2018 were reviewed for this observational study, to identify patients with encephaloceles causing temporal lobe epilepsy (TLE) and treated with surgical resection. Their clinical, radiological, neuropsychological, psychiatric, and surgical data were obtained. Body mass index (BMI) data were also reviewed due to possible correlation between idiopathic intracranial hypertension and encephaloceles. Thirteen patients (eight female) were identified; only three were recognized on initial magnetic resonance imaging (MRI) report. Temporal encephaloceles were identified on the left in eight patients, on the right in three patients, and bilaterally in two patients. One patient had a strong family history of encephaloceles. The median BMI for patients with seizure onset ≤20years of age was 22.4, whereas for patients with onset >20years median BMI was 32.6 (P=.06). Five patients underwent a focal lesionectomy, three patients had limited temporal lobectomy, and five patients had standard anterior temporal lobectomy. Median postoperative follow-up was 5.5years. All but one patient were free of disabling seizures. Nine of ten neuropsychologically tested patients had no discernable cognitive decline postoperatively. Postoperative psychosocial adjustment features were present in four patients. Genetic factors and a possible association with idiopathic intracranial hypertension (given female predominance and elevated BMI) may contribute to the causation of temporal lobe encephaloceles. It is notable that a targeted surgical approach in the management of patients with TLE associated with encephaloceles has an excellent long-term clinical and neuropsychological outcome. Subtle encephaloceles should be actively searched for in patients with drug-resistant TLE because they significantly change surgical strategy and prognostication.

Majority of female bariatric patients retain an obese identity 18-30 months after surgery.

When bariatric surgery is performed, a successful outcome is usually described as % total weight lost (EWL) or a change in BMI. These definitions fail to address the importance of post-operative psychosocial adjustment. Previous research has alluded to a 'mind-body lag' where the patient's experienced body feels larger than their physically smaller post-operative body, perhaps as a result of amygdalae conditioning. The purpose of this study is to further investigate this psychological issue and assess its relationship to health locus of control, alexithymia, health quality of life and weight regain in bariatric surgery patients. Forty female bariatric surgery patients between 18 and 30 months post-op completed demographic data, survey instruments and anthropometric testing. Their evolving self-view, health locus of control, tendency toward alexithymic thought, and health quality of life were measured to identify significant relationships. Hermans' Dialogical Self Theory was used to understand the conflicted self-view of the participants. The majority of participants retained an obese view of self despite weight loss. Those who retained an 'I-obese' viewpoint were significantly more likely to see external situations and powerful others as controlling their weight, have difficulty identifying their feelings and score significantly lower in vitality, social functioning and mental health. Despite losing weight, the majority of participants retained an obese view of self that was significantly associated with a lessened health quality of life. Use of the Evolving Self-View (ESV) exploratory tool may allow early identification of post-operative patients with a prolonged 'I-obese' self-view and provide an opportunity for intervention. Level III, cross-sectional case-controlstudy.

Psychosocial factors associated with in postsurgical prognosis of temporal lobe epilepsy related to hippocampal sclerosis.

We examined the long-term psychosocial trajectory in a consecutive and homogeneous series of 120 patients followed up for five years after corticoamygdalohippocampectomy (CAH). Evaluation of psychosocial variables at baseline and at five-year follow-up were compared. After five years of CAH, a significant improvement in educational level (p=0.004) and employment status (p<0.001) was observed, although retirement (p<0.001) and divorce (p=0.021) rates increased. In a long-term follow-up, a tendency to have similar QOL profile was observed between Engel classes IA and IB (p>0.05). A more favorable surgical outcome (Engel IA) was related to better psychiatric status (p=0.012). Poor psychosocial adjustment before surgery was the most important predictor of QOL outcome (p<0.05). Patients' trajectory after surgical treatment showed positive effects mainly in those with better seizure outcome. Our results emphasized the influence regarding baseline psychosocial functioning on postoperative psychosocial adjustment. Furthermore, many psychosocial gains and difficulties after surgery may be similar in developing and developed countries.

Personality traits predicting long-term adjustment after surgery for ulcerative colitis.

Very few studies have examined the relationship between personality traits and long-term postoperative psychosocial adjustment. In a sample of 46 patients, we examined the relation between personality traits before pelvic pouch surgery for ulcerative colitis and psychosocial adjustment seven years postoperatively, controlling for the effects of surgical functional outcome. The Karolinska Psychodynamic Profile (KAPP) was used for personality assessment. Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale were also used. As assessed by the KAPP, poor frustration tolerance, long-standing preoperative problems in sexual functioning, perfectionistic body ideals, and lack of alexithymia predicted poorer postoperative long-term psychosocial adjustment in the areas of health concerns, sexuality, family relations, and psychological distress. Surgical functional outcome itself was a poor predictor of long-term adjustment. The results indicate that it may be beneficial to take personality factors into account in preoperative assessment.

Hypersexuality after Temporal Lobe Resection

Hypersexuality has occasionally been reported in patients with temporal lobe epilepsy following temporal lobe resection. The mechanism underlying this phenomenon is poorly understood. We describe seven patients who spontaneously reported dramatic postoperative changes in sexual behavior after unilateral temporal lobe resection. Five of the seven patients showed evidence of bilateral temporal lobe abnormalities. All of the patients had significant difficulties with postoperative psychosocial adjustment that preceded the onset of hypersexuality. Five of the patients were completely seizure-free and one reported postoperative auras. Recurrent complex partial seizures occurred at a reduced frequency in one patient after 6 months. In this patient, the period of seizure freedom did not directly correlate with the period of hypersexuality. These cases suggest that hypersexuality following unilateral temporal lobe resection is more likely to occur in the presence of psychosocial difficulties and contralateral temporal lobe abnormalities. Neurophysiological processes associated with seizure cessation alone do not appear to account for postoperative hypersexuality.

Personality predictors of dimensions of psychosocial adjustment after surgery.

Although many studies have examined the relationship between personality factors and adjustment after surgery, most of them have had very short follow-up periods. The present prospective study examines whether preoperative psychodynamic assessment of personality traits enhances prediction of various areas of psychosocial adjustment assessed at least 1 year after surgery. In 53 patients undergoing pelvic pouch surgery for ulcerative colitis, we examined the relationship between personality traits measured before surgery, and postoperative psychosocial adjustment assessed at a median of 17 months postoperatively, controlling for the effect of surgical functional outcome. Personality traits were assessed with the Karolinska Psychodynamic Profile (KAPP). Surgical functional outcome scales and the Psychosocial Adjustment to Illness Scale (PAIS) were used. Problems with sexual satisfaction, perfectionistic body ideals, lack of alexithymia, and poor frustration tolerance predicted poor postoperative adjustment in various areas, beyond what was predicted by surgical functional outcome alone. Moreover, moderate preoperative levels of alexithymia were beneficial to postoperative adjustment in the area of psychological distress. The findings suggest that the preoperative assessment of the patient's long-term sexual functioning and satisfaction, the importance attached to his or her appearance, level of alexithymia, and general capacity to tolerate frustration and set-backs in life, might alert both the surgeon and the patient to potential risk factors for poor postsurgical adjustment.

Neuroticism in Temporal Lobe Epilepsy: Assessment and Implications for Pre‐ and Postoperative Psychosocial Adjustment and Health‐Related Quality of Life

We assessed 77 candidates for epilepsy surgery to determine the association among neuroticism (a dimension of personality characterized by chronic negative emotions and behaviors), psychosocial adjustment as measured by the Washington Psychosocial Seizure Inventory (WPSI), and health-related quality of life (HRQOL) as measured by the Epilepsy Surgery Inventory 55 (ESI-55). Minnesota Multiphasic Personality Inventory 2 (MMPI-2) Neuroticism scale scores were significantly correlated with many domains of patient -perceived psychosocial adjustment and HRQOL regardless of frequency or type of seizures. We then followed 45 of the patients who subsequently underwent epilepsy surgery to determine the influence of neuroticism on postoperative functioning. Two-way analysis of variance (ANOVA) indicated that patients with high preoperative neuroticism had significantly poorer postoperative psychosocial adjustment and HRQOL scores than patients who had low or moderate preoperative neuroticism scores. These results support the validity of the MMPI-2 as a useful measure of neuroticism. Preoperative neuroticism has an important influence on postoperative psychosocial adjustment and HRQOL that is independent of postoperative seizure outcome. Understanding the influence of personality variables, such as neuroticism, on psychosocial functioning both before and after epilepsy surgery is essential in managing intractable seizures.

Patient expectations and postoperative depression, anxiety, and psychosocial adjustment after temporal lobectomy: A prospective study

This study examined the effects of patient expectations on short-term postoperative psychological adjustment alter surgery for epilepsy. Twenty-seven subjects (17 operative, 10 nonoperative controls) agreed to participate. A prospective longitudinal design assessed whether changes in psychosocial functioning had occurred at a mean of 7 weeks after surgery relative to the presurgical assessment. The study also examined the relation between postoperative psychosocial adjustment and preoperative patient expectations. It was found that seizure-free outcomes were associated with significant declines in depression and anxiety. Patients who exhibited preoperative optimistic expectations had lower levels of postoperative depression and anxiety, as long as they were rendered seizure-free. Conversely, those who had optimistic preoperative expectations but were not rendered seizure-free postsurgically continued to exhibit moderate to high levels of depression and anxiety. The theoretical significance of optimistic expectations and their effects on individual self-efficacy are discussed to support the notion that postsurgical adjustment is related to personal coping, even in those patients who are seizure-free after surgery.

Psychosocial function following temporal lobectomy: influence of seizure control and learned helplessness

Learned helplessness is the perception that one's behaviour cannot produce a desired outcome. Individuals with intractable epilepsy who have learned that the occurrence of a seizure is beyond their control can develop such a helpless attitude with cognitive, affective and behavioral components which may generalize to many aspects of life. Post-operative testing was done on 42 patients, aged 17-60 years with I.Q. > 80 who had temporal lobectomies (25 R, 17 L) with follow-up 1-14 years (mean 5 years). In addition to seizure outcome, psychosocial adjustment was measured using the Washington Psychosocial Inventory (WPSI) and a structured interview. Three variables of learned helplessness were also assessed: internal or external locus of control, resourcefulness, and depression. Seizure outcome was: completely seizure free, 36%; > 90% improvement, 38% < 90% improvement, 26%. Overall post-operative psychosocial adjustment was good, marked improvement in lifestyle was noted by 85%, personality change for the better by 65% and improved mood by 47%. A transient mood disorder was noted by 38% in the first six months following surgery. Psychosocial adjustment was better in patients who were seizure free or had > 90% reduction in seizures compared to those with < 90% improvement. Two measures of learned helplessness, depression and lack of resourcefulness correlated with poor postoperative psychosocial adjustment. Other variables beside seizure control must be considered in determining the ultimate outcome of epilepsy surgery.

Learned Resourcefulness and Psychosocial Adjustment Following Temporal Lobectomy in Epilepsy

Learned Resourcefulness and Psychosocial Adjustment Following Temporal Lobectomy in EpilepsyPaul A. Derry, Cathy J. Chovaz, Richard S. McLachlan and Anne CummingsPaul A. DerrySearch for more papers by this author, Cathy J. ChovazSearch for more papers by this author, Richard S. McLachlanSearch for more papers by this author and Anne Cummings1 University Hospital, London, Ontario2 University of Western OntarioSearch for more papers by this authorPublished Online:January 2011https://doi.org/10.1521/jscp.1993.12.4.454PDFPDF PLUS ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations About Previous article Next article FiguresReferencesRelatedDetails Cited byCited by1. Mediating role of psychiatric symptoms on the relationship between learned resourcefulness and life satisfaction among Turkish university studentsOnline publication date: 20 November 2020. Go to citation Crossref Google Scholar2. The benefits of an enhanced Nobody's Perfect Parenting Program for child welfare clients including non-custodial parentsOnline publication date: Go to citation Crossref Google Scholar3. A Reappraisal of the Nobody’s Perfect ProgramOnline publication date: 12 February 2011. Go to citation Crossref Google Scholar4. Learned Resourcefulness and the Long-Term Benefits of a Chronic Pain Management ProgramOnline publication date: 1 October 2008. Go to citation Crossref Google Scholar5. Changes in quality of life and self-perspective related to surgery in patients with temporal lobe epilepsyOnline publication date: Go to citation Crossref Google Scholar6. Psychosocial functioning following surgical treatment for intractable epilepsy in childhoodOnline publication date: 18 February 2003. Go to citation Crossref Google Scholar7. A longitudinal study of the effects of seizure symptoms on the Minnesota Multiphasic Personality Inventory—2 (MMPI-2) clinical interpretationOnline publication date: 1 January 2002. Go to citation Crossref Google Scholar8. Stress responses and adaptation of israeli school-age children evacuated from homes during massive missile attacksOnline publication date: Go to citation Crossref Google Scholar9. Quality of Life of People with Epilepsy following Temporal Lobectomy: A Preliminary ReportOnline publication date: 31 August 2016. Go to citation Crossref Google Scholar10. Psychological Adjustment to Success and to Failure following Epilepsy SurgeryOnline publication date: 2 December 2014. Go to citation Crossref Google Scholar11. Moderators of the Effect of Preoperative Emotional Adjustment on Postoperative Depression After Surgery for Temporal Lobe EpilepsyOnline publication date: Go to citation Crossref Google Scholar12. Opening Versus Closing Strategies in Controlling One’s Responses to ExperienceOnline publication date: Go to citation Crossref Google Scholar13. Influence of seizure content on interpreting psychopathology on the MMPI-2 in patients with epilepsyOnline publication date: Go to citation Crossref Google Scholar14. Health-related quality of life and seizure control in temporal lobe epilepsyOnline publication date: Go to citation Crossref Google Scholar15. Learned Helplessness, Attributional Style, and Depression in EpilepsyOnline publication date: Go to citation Crossref Google Scholar16. Determinants of health-related quality of life after temporal lobe epilepsy surgeryOnline publication date: Go to citation Crossref Google Scholar17. Neuroticism in Temporal Lobe Epilepsy: Assessment and Implications for Pre- and Postoperative Psychosocial Adjustment and Health-Related Quality of LifeOnline publication date: Go to citation Crossref Google Scholar18. Co-operative learning in a university setting: Evidence for the importance of learned resourcefulnessOnline publication date: Go to citation Crossref Google Scholar19. Patient expectations and postoperative depression, anxiety, and psychosocial adjustment after temporal lobectomy: A prospective studyOnline publication date: Go to citation Crossref Google Scholar20. Causal attributions for seizures: Relation to preoperative psychological adjustment and postoperative psychosocial function in temporal lobe epilepsyOnline publication date: Go to citation Crossref Google Scholar Volume 12Issue 4Dec 1993 Information© 1993 Guilford Publications Inc.PDF download

Psychosocial Sequelae of Bariatric Surgery: A Pilot Study

The effects of various preoperative psychiatric parameters on postoperative psychosocial adjustment following bariatric surgery in 29 patients was investigated. Presence of presurgical axis I diagnoses or elevated Beck Depression Index (BDI) scores were associated with postsurgical medical and psychiatric complications; patients without postsurgical complications showed a lack of axis I diagnoses and low BDI scores. Higher presurgery scores on the Bulimia Cognitive-Distortion Scale (BCDS) indicated a trend for occurrence of postsurgical problems. A history of sexual problems was also associated with postsurgical problems.