Preoperative Depressive Symptoms Research Articles

Role of depressive symptoms in patient satisfaction with visual quality after laser in situ keratomileusis

To assess the role of depressive symptoms in patient satisfaction with visual quality after laser in situ keratomileusis (LASIK). Navy Refractive Surgery Center, Ophthalmology Department, Naval Medical Center, San Diego, California, USA. This was a prospective study of active-duty military patients having bilateral conventional LASIK to treat low to moderate myopia with or without astigmatism. Patients completed the Armstrong Laboratory Personality Survey Depression scale preoperatively. Patients were also given a 10-point Navy questionnaire that included an assessment of patient satisfaction with visual quality at the 1- and 6-month follow-up examinations. Patients were stratified by their visual quality rating after LASIK as highly satisfied, satisfied, and less satisfied and by their depression scale score into low, medium, and high groups. A proportional odds model was developed to compare the visual quality rating between the 3 depression groups 1 and 6 months post LASIK. The study comprised 370 patients. An uncorrected visual acuity of at least 20/20 was achieved in 88.6% of eyes. Patients with higher levels of depressive symptoms had 3.0 times higher odds (95% confidence interval [CI], 1.2 to 7.4) of being less satisfied than those with low levels of depressive symptoms 1 month after LASIK (P <or= .02) and 2.5 times higher odds (95% CI, 1.0 to 6.5) of being less satisfied at 6 months (P <or= .06). Preoperative depressive symptoms were a significant contributor to patient satisfaction with visual quality after LASIK.

Is Preoperative Anxiety and Depression Associated with Onset of Delirium After Cardiac Surgery in Older Patients? A Prospective Cohort Study

To investigate the prevalence of preoperative anxiety and depressive symptoms and their relationship with the occurrence of postcardiac delirium and to describe the evolution of these symptoms from preoperative admission until discharge. Descriptive, prospective, longitudinal study. The intensive care unit and two cardiac surgery units in a university hospital setting. One hundred four patients (median age 71; 78.8% men) admitted for elective cardiac surgery. Anxiety measured preoperatively using the State-Trait Anxiety Inventory (STAI) and the Hospital Anxiety and Depression Scale (HADS); depression using the HADS; cognitive functioning using the Mini-Mental State Examination (MMSE); delirium using the Confusion Assessment Method (CAM), the CAM for the Intensive Care Unit (CAMICU), and the Delirium Index (DI); and activities of daily living using the Katz index of activities of daily living (Katz ADL scale). MMSE, CAM/CAM-ICU, and DI were obtained on postoperative Days 1, 3, and 7. On Day 7 and at discharge, the STAI, HADS, and Katz ADL scale were repeated. Postoperative delirium occurred in 26%; 55.8% reported preoperative state anxiety, 25.2% generalized anxiety, and 15.5% depressive symptoms, but no association was found with delirium occurrence. Based on multivariable analysis, prolonged intubation time (odds ratio (OR)51.10, CI: 1.05-1.15, P5.001) and a low intraoperative lowest body temperature (OR50.86, CI: 0.74-0.99, P5.03) were independent predictors of delirium onset. At discharge, 35.7% and 12.2% of patients reported state anxiety and generalized, and 15.3% reported depressive symptoms. Despite the high prevalence of preoperative anxiety and depressive symptoms in older patients with cardiac surgery, no association was found with postoperative delirium.

Depression, Anxiety, and Neuropsychological Performance in Coronary Artery Bypass Graft Patients: A Follow-Up Study

Undergoing coronary-artery bypass surgery (CABG) remains a significant life-event, with an important psycho-emotional impact on patients and their families. The authors examined the incidence and course of depression and anxiety in CABG patients before and after surgery. The long-term relationship between mood disorders and neuropsychological deficits was studied 1 day before and 6 days (N=53), 6 months (N=37), and 3-5 years (N=43) after the procedure. Before surgery, one-third of the patients showed mild-to-moderate cognitive-affective symptoms of depression. After surgery, one-fourth still showed elevated depression scores, whereas anxiety was significantly decreased at all post-operative time-points. Patients with higher pre-operative symptoms of depression showed sustained feelings of depression after surgery. Visuomotor performance was most affected by mood. Data indicated that patients with preoperative moderate cognitive-affective depression could be at risk for sustained feelings of depression even up to 5 years after surgery.

Anxiety and depression as risk factors for mortality after coronary artery bypass surgery

Objective This retrospective study examined the association between symptoms of depression, anxiety, and mortality risk following coronary artery bypass graft (CABG) surgery. Methods We assessed 440 CABG surgery patients' scores on the Depression Anxiety and Stress Scale (DASS) and followed up mortality status for a median of 5 years, 10 months. Results There were 67 (15%) deaths overall during the follow-up period. Adjusted survival analysis showed that preoperative depressive symptoms were not associated with a significantly higher risk of mortality. Survival analysis with preoperative anxiety adjusted for covariates showed a significantly increased mortality risk [hazard ratio (HR)=1.88 (95% CI=1.12–3.17), P=.02]. Conclusion Preoperative anxiety symptoms were significantly associated with increased mortality risk after adjustment for known mortality risk factors. Future research should further explore the simultaneous role of anxiety and depression on mortality following CABG.

Effect of Parathyroidectomy on Quality of Life and Neuropsychological Symptoms in Primary Hyperparathyroidism

Neuropsychological symptoms are found in a certain number of patients with primary hyperparathyroidism (PHPT). Preoperative and postoperative quality of life, anxiety, and depression are measured to analyze the impact of parathyroidectomy on these symptoms. In this prospective study, 66 patients underwent parathyroidectomy for PHPT and were evaluated pre- and postoperatively with two validated psychometric instruments (HADS, PHQ-9). Health-related quality of life was measured with a 12-item short-form health survey (SF-12). Preoperatively, the median physical component score (SF-12) of 43.0 and mental component score of 43.5 were lower than those of the general population (52.8 and 54.2 points, respectively). One year postoperatively the mental component score increased to 48.6 (p = 0.011), whereas the physical functioning scale scored 45.3 and therefore did not change significantly (p = 0.585). Preoperatively, symptoms of depression were found in 23.4% of the patients, and 15.6% of the patients displayed symptoms of anxiety (HADS). The prevalence of depression was significantly higher in patients with preoperative serum calcium levels > 11.2 mg/dl (2.8 mmol/L) (p = 0.015). Twelve months postoperatively, the overall proportion of patients with anxiety and depression decreased to 7.8% and 15.7%, respectively (p = NS). The severity of depression as measured with the PHQ-9 declined postoperatively as well. In this study, preoperative neuropsychological symptoms were related to the serum calcium levels. Postoperative health-related quality of life improved significantly. Among patients with preoperative symptoms of depression and anxiety, both symptoms were alleviated significantly at the 12-month follow-up. Therefore, surgery for PHPT seems to be effective in reducing neuropsychological morbidity associated with PHPT.

Are Preoperative Depressive Symptoms Associated With Postoperative Delirium in Geriatric Surgical Patients?

Delirium is common in older surgical patients and predicts negative health outcomes. Whether depressive symptoms are prevalent and predict the development of postoperative delirium in elderly surgical patients has not been investigated. Our study aimed to examine the prevalence and prognostic importance of preoperative depressive symptoms in older surgical patients. Patients at least 65 years of age who were scheduled for major noncardiac surgery were recruited. Preoperatively, patients were screened for symptoms of depression using the 15-point Geriatric Depression Scale (GDS). Postoperative delirium was measured using the Confusion Assessment Method. The associations between covariates and preoperative depression, and postoperative delirium were determined by multivariate logistic regression. In the 219 patients studied, the mean age was 73.6 +/- 6 years, 12% of patients reported six or more depressive symptoms, and 32% reported three to five depressive symptoms. By multivariate logistic regression, patient characteristics associated with six or more symptoms of depression included <12 years of education, moderate to severe limitation in functional status, and drinking more than two alcoholic beverages per day. Postoperatively, 46% of patients developed delirium. Patients with a greater number of preoperative depressive symptoms were more likely to develop postoperative delirium (p =.048) and experience a longer duration of postoperative delirium (p =.027). Even after adjusting for covariates associated with depression and postoperative delirium--including age, educational level, functional status, and preoperative alcohol use--patients with more than six preoperative depressive symptoms were still significantly more likely to have a longer duration of postoperative delirium than did those patients with fewer than two depressive symptoms (odds ratio = 2.69, confidence interval = 1.04-6.93). Preoperative screening for the presence of depressive symptoms can be performed easily in elderly patients, and yields useful prognostic information relating to postoperative delirium.

Sex differences in depression after coronary artery bypass graft surgery

Previous research suggests that after coronary artery bypass graft (CABG) surgery, women fare worse than men. This study investigates sex differences in depression during recovery from CABG surgery. We followed 137 patients (72 men, 65 women) undergoing elective isolated first CABG surgery between July 2003 and April 2004. Patients were interviewed < or = 28 days before surgery and between 6 and 12 weeks after surgery. Patients completed a structured diagnostic interview for major depressive disorder (MDD) and the Beck Depression Inventory (BDI). Clinical data were retrieved from patient charts. Prevalence of MDD before surgery was 28.2%, but decreased to 16.4% after surgery (P = .038). Women had significantly more depressive symptoms than men pre-CABG, with a mean BDI of 12.5 (95% CI 10.6-14.4) for women versus 8.0 (95% CI 6.3-9.8) for men (P = .0001), but not post-CABG. There was a significant sex-by-time interaction with depressive symptoms in women improving almost 6-fold more than in men, with BDI change scores of 4.1 (95% CI 2.0-6.1) for women versus 0.7 (95% CI-1.0-2.5) for men (P = .008). The interaction remained significant after adjusting the model for the predetermined baseline characteristics education, social support, and operative risk. Women had more depressive symptoms than men pre-CABG, but improved to a level comparable to men post-CABG. Women benefited from CABG as much or more than men in terms of their mental health. Preoperative depressive symptoms should not preclude women from CABG surgery.

Quality of Life Following Cardiac Surgery: Impact of the Severity and Course of Depressive Symptoms

The purpose of this study was to examine the impact of the severity and course of depressive symptoms on change in quality of life (QOL) 6 months after cardiac surgery. Ninety patients were interviewed before heart surgery and 2 and 6 months after surgery. Depressive symptoms were assessed using the Beck Depression Inventory, and QOL was assessed using physical and psychosocial functioning indices derived from the Medical Outcomes Study instrument. Multiple regression examined the effects of the severity and course of depressive symptoms on QOL adjusting for demographic and biomedical predictors. Higher levels of presurgical depressive symptoms predicted poorer physical functioning after cardiac surgery. A similar effect on psychosocial functioning fell short of significance. An increase in depressive symptoms 2 months after surgery was significantly predictive of poorer physical and psychosocial functioning at 6 months. The effect of increased depressive symptoms on psychosocial functioning was significantly stronger in patients with high presurgical Beck Depression Inventory scores. Both preoperative depressive symptoms and postoperative increases in depressive symptoms seem associated with poorer QOL 6 months after cardiac surgery. Further examination of these associations and the mechanisms they reflect may provide a basis for guiding treatment decisions before and after coronary artery bypass graft surgery.

Predictors and outcomes of delirium

Objectives To determine factors associated with the occurrence of delirium among patients undergoing surgical repair of abdominal aortic aneurysm (AAA). Methods The sample included all consenting patients who underwent AAA repair during a 12-month period. Before surgery, daily while in hospital, and at 1 and 6 months after surgery, we assessed patients' mood, mental status and functional status. We compared delirious and nondelirious patients for severity of preoperative depressive symptoms, length of hospital stay and mortality. The effects of delirium on postoperative functional status were assessed in conjunction with postoperative depressive symptoms using regression models. Results The sample of 35 patients was primarily male and elderly; one-quarter had three or more medical conditions; and eight (23%) developed delirium after surgery. Postoperative delirium was significantly associated with preoperative depressive symptoms, alcohol use and cognitive impairment as well as with longer lengths of stay and poorer functional status at 1 and 6 months after surgery. Conclusion Identification and treatment of patients with depressive symptoms, alcohol use and cognitive impairment prior to AAA surgery could reduce the incidence of postoperative delirium and the prolonged hospital stays and impaired functional status associated with it. Surgeons should consider using simple screening instruments before surgery to identify patients at risk and referring them for psychiatric evaluation and treatment. They should also consider including psychiatrists early in the care of high-risk patients to improve detection of and early intervention for delirium.

Risk factors for postoperative delirium in vascular surgery

The aim of this study was to identify psychiatric and somatic risk factors associated with the development, severity and duration of postoperative delirium after vascular surgery. Forty-seven patients underwent aortic, carotid artery and peripheral artery surgery. Both, surgeon and psychiatrist, monitored patients preoperatively with daily follow up. Preoperative psychiatric assessment included standardized psychopathological scales for the detection of psychiatric symptoms and cognitive deficits. We diagnosed delirium using DSM IV criteria. Delirium Rating Scale was used to estimate delirium severity. Surgical parameters included patient history, diagnoses, medication and laboratory parameters. A statistical analysis was performed using multivariate regression analyses to find factors significantly associated with delirium development, severity, and duration. Thirty-six percent of the patients developed postoperative delirium after surgery. Comparison of different parameters revealed that especially preoperative depression symptoms and perioperative transfusions/infusions had significant predictive value for the development as well as for the severity of postoperative delirium.

Preoperative depression and mortality in coronary artery bypass surgery: preliminary findings.

There is convincing evidence to suggest that depression significantly increases the risk of mortality following myocardial infarction. There are few data concerning depression as a risk factor for mortality following cardiac surgery. The aim of the present observational study was to determine if preoperative depressive symptoms resulted in an increased risk of late mortality following cardiac surgery. Preoperative assessments of depressive symptoms were performed on 158 patients undergoing coronary artery bypass surgery. Elevated preoperative depression symptoms were defined as a depression anxiety stress scale score of > or = 10. Twenty-four of the 158 patients ( 15.2%) were classified as having elevated preoperative depressive symptoms. Patients were followed for a median of 25 months (range: 4-38 months). Three of the 24 patients (12.5%) with preoperative depressive symptoms died within the follow-up period, compared with three of the 134 (2.2%) non-depressed patients (odds ratio: 6.24; 95% CI: 1.18-32.98; P = 0.046). There were no other group differences on variables including population demographics, medical risk factors, surgical parameters, and indices of postoperative morbidity. Elevated depressive symptoms before coronary bypass surgery may be a significant predictor of late death. Prospective studies evaluating the prevalence of depressive symptoms in cardiac surgical patients and their effect on long-term outcome must be undertaken.

Does preoperative depression predict increased late mortality in cardiac surgical patients?

Introduction. There is convincing evidence to suggest that depression significantly increases the risk of mortality after myocardial infarction [1, 2]. The aim of this observational pilot study was to determine whether preoperative depressive symptoms result in an increased risk of mortality after discharge after cardiac surgery.