Prediction of anxiety and depression in general surgery inpatients: A prospective cohort study of 200 consecutive patients

Preoperative anxiety, postoperative pain tolerance and analgesia consumption: A prospective cohort study

BACKGROUND

Anxiety affects the patient's perception of postoperative pain and causes a significant increase in the consumption of analgesia postoperatively.

OBJECTIVE

This study assesses the relationship between preoperative anxiety, postoperative pain and postoperative pethidine consumption.

METHODS

A prospective cohort design was used. Data were collected from 100 patients who were undergoing a laparoscopic cholecystectomy at St Joseph Hospital, Jerusalem. Pain-controlled analgesia with pethidine was utilised to manage pain throughout the postoperative period. The visual analogue scale scores and pethidine consumption of all patients were recorded.

FINDINGS

Participants' mean level of pain was higher in the preoperative period (mean visual analogue scale = 1.3) compared with their mean level of pain in the postoperative period (mean visual analogue scale = 0.5). There is a statistically significant difference between the participants' level of anxiety and postoperative pain level (p < 0.001). Gender, weight, level of education and smoking were predictors of developing preoperative anxiety. Also, gender, smoking and medication were statistically significant predictors of developing postoperative pain. Furthermore, gender, medical history and medication were statistically significant predictors of pethidine consumption postoperatively.

CONCLUSIONS

The preoperative anxiety reduction intervention should be promoted and implemented as routine care for all surgical patients.

Perceived compassionate care and preoperative anxiety in hospitalized patients

BACKGROUND

Quality nursing care and ethical responses to patient pain and suffering are very important in the preoperative period. However, few studies have addressed these variables.

OBJECTIVE

This study aimed to examine the relationship between compassionate care and preoperative anxiety from the perspective of hospitalized patients.

METHODS

The current study was a cross-sectional descriptive one. The participants were selected using convenience sampling. The data were collected using a demographic questionnaire, Burnell Compassionate Care Tool, and Amsterdam Preoperative Anxiety and Information Scale (APAIS). The collected data were analyzed with SPSS software (version 22) through descriptive and inferential statistics at a significance level of 0.05 (p < .05).

PARTICIPANTS AND SETTING

This study was conducted on 704 candidates for surgery in the internal and surgical wards of a large teaching hospital located in the south of Iran from December 2022 to March 2023.

ETHICAL CONSIDERATIONS

The protocol for this study was reviewed and approved by the University Ethics Committee.

FINDINGS

The patients' average age was 36.61 ± 13.07. The average preoperative anxiety and need for information scores were 13.80 ± 2.66 and 7.44 ± 1.47, respectively. The average score of importance was 3.03 ± 0.19, and the average score of the extent of compassionate care provision was 1.22 ± 0.15. There was a significant relationship between preoperative anxiety with importance and the extent of compassionate care provision (r = 0.68, p < .001), r = -0.72, p < .001, respectively). A comparison of the demographic characteristics, need for information, importance, and provision of compassionate care showed that the extent of compassionate care provision had the greatest contribution in explaining preoperative anxiety (β = 0.50; p < .001).

CONCLUSION

Even though patients' preoperative anxiety was high and providing compassionate care in the preoperative period had a great role in relieving their anxiety, many participants appear to have received little compassionate care. To this end, nursing managers should pay attention to the quality of compassionate care in the preoperative stage. Besides, healthcare staff should receive the necessary training in compassionate nursing care.

The association between cataract surgery and mental health in older adults: a review

BACKGROUND

Although cataract surgery has been proposed as a potentially modifiable protective factor for enhancing emotional well-being in cataract patients, studies examining the relationship between anxiety or depression and cataract surgery have yielded inconsistent findings. This review summarizes existing evidence to establish whether cataract surgery is associated with depression and anxiety in older adults.

METHODS

A literature search was conducted across PubMed, Medline, Web of Science, and Embase databases. An initial screening by abstracts and titles was performed, followed by a review and assessment of the methodological quality of the relevant full papers, and final inclusion of 44 studies were deemed eligible for inclusion in this review.

RESULTS

Among 44 included studies, 36 studies (81.8%) were observational studies concerning the association of cataract surgery or cataracts with anxiety or depression, four studies (9.1%) were interventional studies, and four studies (9.1%) were reviews. Cataract surgery notably enhances the mental health of individuals with impaired vision. However, the multifaceted nature of psychological well-being, influenced by various factors, suggests that cataract surgery may not address all aspects comprehensively. Additionally, preoperative anxiety and depression significantly impact cataract surgery outcomes.

CONCLUSION

Vision impairment in older adults is closely associated with increased symptoms of depression and anxiety. While surgical intervention for cataracts improves these symptoms, it might be less effective for mental disorders with multifactorial causes. Notably, anxiety or depression poses challenges to successful preoperative and intraoperative cataract surgeries.

Anxiety in patients with gastrointestinal cancer undergoing primary surgery

PURPOSE

Anxiety in the perioperative period is not only an unpleasant emotional state, but can also negatively affect the outcomes and quality of life of surgical patients. The present study investigated anxiety in patients with gastrointestinal cancer scheduled for primary surgery.

METHODS

A total of 101 patients in four non-university surgical departments were included. Anxiety (GAD-7), depression (PHQ-9), distress (Distress thermometer), and illness perception (Brief IPQ) were assessed at four time points: first outpatient contact before surgery (t1), preoperative inpatient contact (t2), postoperative inpatient contact before hospital discharge (t3), and postoperative outpatient follow-up contact after 30 days (t4).

RESULTS

56% of patients had an episode of mild or moderate anxiety and 5% had an episode of severe anxiety and/or depression. Subjectively perceived anxiety and depression were highest at t1, followed by t3. 30% of patients had elevated anxiety and depression scores at t1. Regression analyses showed that high subjectively perceived mental distress at t1 was associated with higher anxiety scores at t3 and t4. Women, and younger women in particular, were significantly more likely to experience stress than men. Higher levels of subjectively perceived stress at t1 were associated with higher levels of anxiety at t3 and t4. Sociodemographic factors were not relevant predictors of anxiety.

CONCLUSION

Anxiety and depression appear to be a persistent problem during the perioperative course in patients with gastrointestinal tumors. Identifying patients at risk for clinically relevant anxiety and depression remains a particular challenge. The results confirm the relevance of repeated screening for mental distress.

Risk factors for new antidepressant use after surgery in Sweden: a nationwide, observational cohort study

Background

Whilst somatic complications after major surgery are being increasingly investigated, the research field has scarce data on psychiatric outcomes such as postoperative depression. This study evaluates the impact of patient and surgical factors on the risk of depression after surgery using the proxy measure of prescribed and collected antidepressants.

Methods

An observational, registry-based, national multicentre cohort study of individuals ≥18 yr of age who underwent noncardiac surgery between 2007 and 2014. Exclusion criteria included history of antidepressant use defined by collection of a prescription within 5 yr before surgery. Participants were identified using a surgical database from 23 Swedish hospitals and data were linked to National Board of Health and Welfare registers for collection of prescribed antidepressants. Descriptive statistics were used for baseline data and logistic regression for predictive factors.

Results

Of 223 617 patients, 4.9% had a new prescription of antidepressants collected 31-365 days after surgery. Antidepressant prescription was associated with increasing age, female sex, and more comorbidities. The incidence of antidepressant prescription was highest after neurosurgery, vascular, and thoracic surgery. Affective and anxiety disorders were risk factors. In the whole cohort and within the aforementioned surgical subtypes, acute and cancer surgery increased the risk of antidepressant prescription.

Conclusions

This study brings novel insights to the epidemiology of postoperative antidepressant treatment in antidepressant-naive patients. One in 20 postoperative patients are prescribed antidepressants but with knowledge of risk factors, interventional strategies can be tested.

Effect of music listening on perioperative anxiety, acute pain and pain catastrophizing in women undergoing elective cesarean delivery: a randomized controlled trial

BACKGROUND

Anxiety may adversely impact mother and her newborn. Music listening is a safe and efficacious treatment that may to reduce perioperative anxiety. The effect on acute pain and pain catastrophizing scores remains unclear. We aimed to determine whether perioperative music listening reduces anxiety, acute pain, and pain catastrophizing scale (PCS) scores following elective cesarean delivery under spinal anesthesia.

METHODS

After randomization into music listening and control groups, baseline patient characteristics, visual analog scale-anxiety (VAS-A) scores, pain scores, PCS total and sub-scores, and music preferences were collected preoperatively. Before surgery, parturients in the experimental group listened to music of their own choice for 30 min. Music listening was continued during administration of spinal anesthesia and cesarean delivery, and for 30 min following surgery. Postoperative VAS-A score, acute pain score, PCS scores, music preferences, satisfaction score, and feedback were recorded.

RESULTS

We analyzed 108 parturients (music: n = 53; control: n = 55). Music listening was associated with reduced postoperative VAS-A (mean difference (MD) -1.43, 95%CI -0.63 to -2.22), PCS total score (MD -6.39, 95%CI -2.11 to -10.66), PCS sub-scores on rumination (MD -1.68, 95%CI -0.12 to -3.25), magnification (MD -1.53, 95%CI -0.45 to -2.62), and helplessness (MD -3.17, 95%CI -1.29 to -5.06) sub-scores. There was no significant difference in postoperative acute pain scores. The majority (> 95%) of parturients reported "excellent" and "good" satisfaction with music listening, and most provided positive feedback.

CONCLUSION

Perioperative music listening was associated with reduced postoperative anxiety and lower pain catastrophizing. Based on the good patient satisfaction and positive feedback received, the use of music listening in the obstetric setting is recommended.

TRIAL REGISTRATION

This study was registered on Clinicaltrials.gov NCT03415620 on 30/01/2018.

The overlooked problem among surgical patients: Preoperative anxiety at Ethiopian University Hospital

Introduction

Anxiety was repeatedly reported as the worst aspect of the perioperative time. The objective of this study was to assess the prevalence of preoperative anxiety among adult surgical patients at University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia.

Methodology

A hospital-based cross-sectional study was conducted among surgical patients at the university hospital. After obtaining ethical approval, 407 surgical patients were approached during the preoperative period. Preoperative anxiety was assessed by State-Trait Anxiety Inventory. The association between variables was determined by using binary logistic regression analysis. Strength of association was described in adjusted odds ratio (AOR), and a p-value < 0.05 at 95% confidence interval was considered statistically significant.

Results

A total of 400 patients were included in this study with a 98.3% response rate. Preoperative anxiety was observed among 237 (59.3%) patients, and the median (IQR) STAI score was 50 (40-56.7); age, ≥ 60 years (AOR: 5.7, CI: 1.6-20.4, P: 0.007); emergency surgery (AOR: 2.5, CI: 1.3-4.7, P: 0.005); preoperative pain (AOR: 2.6, CI: 1.2-5.4, P: 0.005); and rural residency (AOR: 1.8, CI: 1.1-2.9, P: 0.031) were found significantly associated with preoperative anxiety.

Conclusion

The prevalence of preoperative anxiety among surgical patients was high. Older age (≥ 60 years), emergency surgery, preoperative pain, and rural residency were found significantly associated with preoperative anxiety. Assessment for preoperative anxiety should be a routine component of preoperative assessment of both elective and emergency surgical patients. Preoperative pain should be appropriately managed as it can help to reduce preoperative anxiety. Optimal anxiety reduction methods should be investigated and implemented in the hospital.

A randomised pilot trial of virtual reality-based relaxation for enhancement of perioperative well-being, mood and quality of life

A cancer diagnosis and subsequent treatment can trigger distress, negatively impact coping resources, and affect well-being as well as quality of life. The aim of this pilot study was to investigate feasibility and clinical effects of a VR intervention on quality of life, well-being and mood in cancer patients undergoing surgery compared to a non-VR intervention and a control group. 54 patients with colorectal cancer or liver metastases from colorectal cancer undergoing elective curatively intended surgery were recruited and randomised to one of two intervention groups or a control group receiving standard treatment. Participants assigned to one of the intervention groups either received a VR-based intervention twice daily or listened to music twice daily. Adherence to the intervention was 64.6% in the music group and 81.6% in the VR group. The VR intervention significantly reduced heart rate (- 1.2 bpm; 95% CI - 2.24 to - 0.22; p = 0.02) and respiratory rate (- 0.7 brpm; 95% CI - 1.08 to - 0.25; p = 0.01). Self-reported overall mood improved in both groups (VR: + 0.79 pts; 95% CI 0.37-1.21; p = 0.001; music: + 0.59 pts; 95% CI 0.22-0.97; p = 0.004). There was no difference in quality of life between the three groups. Both interventions groups reported changes in feelings. Adherence rates favoured the VR intervention over the music group. Observed clinical outcomes showed stronger intragroup effects on mood, feelings, and vital signs in the VR group. The study demonstrated feasibility of a VR intervention in cancer patients undergoing surgery and should encourage further research investigating the potential of VR interventions to positively influence well-being and mood in cancer patients.

Impact of Mental Health on General Surgery Patients and Strategies to Improve Outcomes

Mental Health Disorders (MHD) are a growing concern nationwide. The significant impact MHD have on surgical outcomes has only recently started to be understood. This literature review investigated how mental health impacts the outcomes of general surgery patients and what can be done to make improvements. Patients with schizophrenia had the poorest surgical outcomes. Mental health disorders increased post-surgical pain, hospital length of stay, complications, readmissions, and mortality. Mental health disorders decreased wound healing and quality of care. Optimizing outcomes will be best accomplished through integrating more effective perioperative screening tools and interventions. Screenings tools can incorporate artificial intelligence, MHD data, resilience and its biomarkers, and patient mental health questionnaires. Interventions include cognitive behavioral therapy, virtual reality, spirituality, pharmacology, and resilience training.

Preoperative Anxiety is Associated With Postoperative Complications in Vascular Surgery: A Cross-Sectional Study

BACKGROUND

Preoperative anxiety is associated with increased morbidity and/or mortality in surgical patients. This study investigated the incidence, predictors, and association of preoperative anxiety with postoperative complications in vascular surgery.

METHODS

Consecutive patients undergoing aortic, carotid, and peripheral artery surgery, under general and regional anesthesia, from February until October 2019 were included in a cross-sectional study. Anesthesiologists assessed preoperative anxiety using a validated Serbian version of the Amsterdam Preoperative Anxiety and Information Scale. Patients were divided into groups with low/high anxiety, both anesthesia- and surgery-related. Statistical analysis included multivariate linear logistic regression and point-biserial correlation.

RESULTS

Of 402 patients interviewed, 16 were excluded and one patient refused to participate (response rate 99.7%). Out of 385 patients included (age range 39-86 years), 62.3% had previous surgery. High-level anesthesia- and surgery-related anxieties were present in 31.2 and 43.4% of patients, respectively. Independent predictors of high-level anesthesia-related anxiety were having no children (OR = 0.443, 95% CI: 0.239-0.821, p = 0.01), personal bad experiences with anesthesia (OR = 2.294, 95% CI: 1.043-5.045, p = 0.039), and time since diagnosis for ≥ 4 months (OR = 1.634, 95% CI: 1.023-5.983, p = 0.04). The female sex independently predicted high-level surgery-related preoperative anxiety (OR = 2.387, 95% CI: 1.432-3.979, p = 0.001). High-level anesthesia-related anxiety correlated with postoperative mental disorders (r_pb = 0.193, p = 0.001) and pulmonary complications (r_pb = 0.104, p = 0.042). Postoperative nausea (r_pb = 0.111, p = 0.03) and postoperative mental disorders (r_pb = 0.160, p = 0.002) correlated with high-level surgery-related preoperative anxiety.

CONCLUSIONS

Since preoperative anxiety affects the postoperative course and almost every third patient experiences anxiety preoperatively, routine screening might be recommended in vascular surgery.

Effect of electroacupuncture on discomfort during gastroscopy: a study protocol for a randomized controlled trial

Background

Gastroscopy procedures are frequently performed under general sedation to minimize discomfort. Patients who refuse a sedative injection may experience more discomfort and adverse reactions such as pain and nausea. These instances reduce patient compliance and willingness to participate in future procedures. Acupuncture has been shown to have an anti-nausea and analgesic effect; however, there is limited data available that demonstrates the efficacy of acupuncture when applied before gastroscopy.

Methods

A total of 60 participants will be randomly assigned to the electroacupuncture (EA) group and the sham electroacupuncture (SEA) group at a ratio of 1:1. Acupuncture treatment will be performed before gastroscopy for a duration of 30 min. All patients will complete detailed questionnaires at 30 min and 7 days post-procedure to record the severity of their symptoms. The primary outcome will be the average of 4 standard visual analogue scale (VAS) scores in the categories of nausea, vomiting, throat discomfort, and agitation as reported by the patient. The secondary outcomes will be patient’s anxiety level as recorded by the 6-item short form of the State-Trait Anxiety Inventory (STAI-S6) and Amsterdam Pre-Operative Anxiety and Information Scale (APAIS), preference in a future endoscopy, pulse oxygen saturation (SpO2), heart rate (HR), and blood pressure (BP). Anxiety scales will be assessed before and after acupuncture; others will be completed at 30 min and 7 days post-procedure. The duration of the gastroscopy and the number of biopsies will be recorded after operation.

Discussion

This randomized controlled trial will explore the feasibility of the further clinical application of electroacupuncture for the improvement of patient discomfort during gastroscopy without systemic sedation.

Trial registration

ChiCTR2000040726. This trial has been approved by the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine (2020SHL-KY-11). Registration date 12 August 2020.

Financial Toxicity and psychological distress in Adults with Cancer: A Treatment-based Analysis

Objective

To evaluate disparities in financial toxicity and psychological distress in patients with cancer as a function of treatment and reveal the relationship between financial toxicity and psychological distress.

Methods

This was a multicenter cross-sectional study. Patients were recruited from March 2017 to October 2018, and questionnaires were completed regarding their demographics, financial toxicity, and psychological distress. A multiple linear regression model was used to examine factors associated with financial and psychological distress.

Results

Significant financial toxicity and psychological distress occurred in 47.9% and 56.5% of patients, respectively. Financial toxicity (P ​= ​0.032) and psychological distress (P ​< ​0.001) were statistically different among the single chemotherapy, adjuvant therapy, and surgery groups. Multivariable analysis revealed that patients aged 50–59 years (P ​= ​0.035), 60–69 years (P ​= ​0.007), and 70 years or older (P ​= ​0.002) had higher the Comprehensive Score for financial Toxicity (COST) scores compared with patients less than 50 years old. Patients with personal annual income > 40,000 CNY reported higher COST scores than those who had < 20,000 CNY (P ​< ​0.001). Patients who had Urban Resident Basic Medical Insurance (URBMI) (P ​= ​0.030) or New Rural Cooperative Medical Scheme (NRCMS) (P ​= ​0.006) compared with Urban Employee Basic Medical Insurance (UEBMI) presented lower COST scores than patients with UEBMI. The multiple analysis model of psychological distress showed that an age of more than 70 years (P ​= ​0.010) was significantly associated with low the Distress Thermometer (DT) scores, and patients with colorectal cancer (P ​= ​0.009), the surgery group (P ​< ​0.001) and adjuvant therapy group (P ​< ​0.001) were significantly associated with high DT scores. The correlations between financial toxicity and psychological distress were mild but statistically significant in the chemotherapy-related treatment groups.

Conclusions

The research highlights the high rates of financial and psychological distress in adult patients. Multidimensional distress screening and psychosocial interventions should be provided for patients with cancer according to related factors.

Adhésion et implémentation d’un programme de cohérence cardiaque visant à réduire l’anxiété de patients opérés pour une carcinose péritonéale : étude pilote randomisée

Objectif : Évaluer l’implémentation d’une pratique quotidienne de cohérence cardiaque chez des patients opérés pour une carcinose péritonéale.

Matériel et méthode : Étude pilote monocentrique, ouverte, contrôlée, randomisée non comparative, incluant 20 patients en soins courants vs 40 patients formés à la cohérence cardiaque avec biofeedback et guide respiratoire pour une pratique au domicile enregistrée.

Résultats attendus : Adhésion satisfaisante au programme, pouvant caractériser les éléments favorisant son implémentation avant et après chirurgie et évaluation de son impact sur l’anxiété.

Perspectives : Efficacité à déterminer pour transférer ce soin de support.

Magnitude and factors associated with preoperative depression among elective surgical patients at University of Gondar comprehensive specialized hospital, North West Ethiopia: A cross-sectional study

Background

Depression one of the world's prevalent mental illnesses is a leading cause of major public health problems globally and its frequency has been increasing, particularly in low and middle-income countries. Little is known about the magnitude and contributing factors of preoperative depression among elective surgical inpatients in the country and in the study area as well. The aim of the current study was to assess the magnitude and factors associated with preoperative depression among elective surgical inpatients.

Method

A cross-sectional study was conducted from May 01, 2021 to June 30, 2021 among preoperative surgical inpatients at University of Gondar comprehensive specialized hospital. Non probability sampling was used. A nine-item questionnaire screening tool was used to assess depression. We computed the bi-variable and multivariable binary logistic regression analyses. Crude and adjusted odds ratio with 95% confidence interval were used.

Result

The magnitude of depression was 28.3%. In the multivariable logistic regression analysis female (AOR = 2.27, 95% CI: 1.15, 4.5), being widowed (AOR = 3.271, 95% CI: 1.25, 8.56), divorced (AOR = 3.41, 95% CI: 1.13, 10.26), length of hospital stay of 7–14 days (AOR = 2.7, 95%CI: 1, 7.2) and more than 14 days (AOR = 3.19, 95% CI: 1.3, 7.8), having co-existing diseases (AOR = 2.78, 95%CI: 1.28, 6.02), current history of pain (AOR = 3.12, 95%CI: 1.6, 5.7), admission to orthopedics (AOR = 3.28, 95%CI: 1.55, 6.95) and gynecology ward (AOR = 2.43, 95% CI: 1.03, 5.7) and poor social support AOR = 2.24, 95% CI: 1.1, 4.6) were significantly associated with depression.

Conclusion

The magnitude of pre-operation depression was 28.3%. Female, Widowed, being divorced, length of hospital stays, coexisting chronic illness, current history of pain, admission at orthopedic and gynecology wards and poor social support were factors significantly associated with depression. We recommend strengthening the linkage of the psychiatric department with preoperative patients to provide psychotherapy behavioral modification.

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Depression is one of the world's mental illnesses problem.

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Little is known about prevalence and its contributing factors of preoperative depression.

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Surgical patients with Preoperative depression have major post-operative complications.

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The prevalence of preoperative depression among surgical inpatient was 28.3%.

Surgical Anxiety Questionnaire: Turkish validity and reliability

The preoperative anxiety is common and the reported prevalence of preoperative anxiety among patients that underwent various types of surgery was found as high as 60%-90%. If anxiety before surgical intervention is not well managed, it may delay surgery due to changes in vital signs and increase the possibility of complications developing postoperatively. The aim of this study is to determine the reliability and validity of the Turkish version of Surgical Anxiety Questionnaire. This methodological study was conducted with 204 patients who agreed to participate in the study in Turkey. Before beginning the study, institutional permission was obtained from Provincial Health Directorate to perform the research in state hospital located in province. Ethics committee permission was obtained from University Clinical Research Ethics Committee. Cronbach's alpha reliability coefficient, Pearson's correlation, factor analysis, Bartlett test, Kaiser-Meyer-Olkin (KMO) test and correlation were used in the assessment of the data obtained. The level of significance was accepted as 0.05. In this study, the Cronbach α coefficients for the Surgical Anxiety Questionnaire were 0.844 for the whole scale, 0.836 for the Anxiety related to Health subdimension, 0.734 for the Anxiety related to Recovery subdimension and 0.707 for the Anxiety related to Procedure subdimension. The item total point correlation values for the Surgical Anxiety Scale were found to be between 0.247 and 0.673. It is concluded that the Turkish version of Surgical Anxiety Scale is valid and reliable for surgical patients, in clinical and scientific research studies.

Familial Mediterranean fever: Health-related quality of life and associated variables in a national cohort

Objectives

This study aims to evaluate the effectivity of Familial Mediterranean Fever Quality of Life (FMF-QoL) Scale for the measurement of QoL in patients with FMF and to perform correlations between related clinical variables in Turkish patients.

Patients and methods

This multicenter prospective study performed between December 2017 and November 2018 included 974 FMF patients (334 males, 640 females; median age: 35; range, 26 to 45 years). Sociodemographic characteristics and clinical features were recorded. All participants were asked to complete the FMF-QoL Scale, Short Form-36 (SF-36), Hospital Anxiety and Depression Scale (HADS), Health Assessment Questionnaire (HAQ), and Functional Assessment of Chronic Illness Therapy (FACIT) Scale.

Results

The median FMF-QoL Scale score was 26. Higher FMF-QoL Scale scores were shown to be related to female sex, illiteracy or primary education, monthly low-income (US$<300), smoking, late-onset FMF (>20 years), a higher number of attacks per month (>1/month), and severe disease. FMF-QoL Scale scores were correlated negatively with subscales of SF-36, and positively with HADS-anxiety and HADS-depression scores, HAQ and FACIT.

Conclusion

Female sex, smoking, lower educational status, more severe disease, fatigue, and functional impairment were associated with poor QoL. FMF-QoL Scale was noted as a valid and simple patient-reported outcome instrument and correlated with the SF-36 scale.

Art Heals: Randomized Controlled Study Investigating the Effect of a Dedicated In-house Art Gallery on the Recovery of Patients After Major Oncologic Surgery

INTRODUCTION

We sought to investigate the effect of exposure to a dedicated art gallery during the perioperative period on the recovery of patients undergoing major oncologic procedures.

METHODS

Eighty patients were randomized into 2 arms; standard of care versus exposure to art. All patients completed a survey assessing their baseline art knowledge, and 4 poststudy validated questionnaires assessing their pain (Pain Rating Scale), hope (Herth Hope Index), anxiety (State-Trait Anxiety Inventory for Adults), and mental wellbeing (Warwick-Edinburgh Mental Wellbeing Scale). A linear model adjusted for baseline scores was run comparing the scores among the 2 study arms. Stepwise multivariate regression analyses were used to identify predictors of improved pain, hope, anxiety, and wellbeing.

RESULTS

Both groups were comparable in terms of demographics, passion, and knowledge about art. There was no statistically significant difference in pain scores between the 2 groups. The exposure to art group experienced higher hope (2.4 points higher vs 0.05, P = 0.004), lower anxiety (8 points lower vs -0.9, P < 0.0001), and higher mental well-being scores (5.23 points higher vs -0.05, P < 0.0001) in comparison to the standard of care group. On multivariate analyses, exposure to art was significantly associated with improved hope, anxiety, and mental well-being after adjusting for patient and disease characteristics.

CONCLUSIONS

Dedicated exposure to art was associated with improved hope, anxiety, and mental well-being of patients after major oncologic surgery.

Evaluating the Depression, Anxiety, Stress, and Predictors of Psychological Morbidity Among COVID-19 Survivors in Mashhad, Iran

Background: The outbreak of coronavirus disease 2019 (COVID-19) pandemic has led to public panic and psychological problems. In this regard, few studies have reported the post-discharge mental health status of COVID-19 survivors. Objectives: This study aimed to evaluate the mental health status of COVID-19 survivors and determine the risk factors of adverse psychological outcomes. Methods: This cross-sectional study consisted of 188 COVID-19 survivors discharged from hospital. Data were recorded using social media applications. To evaluate the mental health status, Hospital Anxiety and Depression Scale (HADS) and Depressive Anxiety and Stress Scale 42 (DASS-42) were used. Ordinal regression with a logit link was used to assess the simultaneous effect of variables. Results: The mean age of participants was 56.4 ± 9.6 years, and the majority of patients were male (62.2%). According to HADS, 81 (43.1%) and 24 (12.8%) patients suffered from anxiety and depression, respectively. Using DASS-42, we reported at least a mild degree of depression [23 (12.2%)], anxiety [20 (10.6%)], and stress [74 (39.4%)] among the discharged patients. Depression, anxiety, and stress were significantly associated with length of hospital stay (P < 0.05). In addition, there was a direct association between stress and patients’ number of children (β = 0.38, P = 0.02). Conclusions: Depression, anxiety, and stress are relatively high among COVID-19 survivors. Length of hospital stay and number of children were identified as the predisposing factors for adverse psychological outcomes.

Virtual reality-based relaxation for enhancement of perioperative well-being and quality of life: protocol for a randomised pilot trial

INTRODUCTION

Patients with cancer undergoing surgery often suffer from reduced quality of life and various forms of distress. Untreated distress can negatively affect coping resources as well as surgical and oncological outcomes. A virtual reality-based stress reduction intervention may increase quality of life and well-being and reduce distress in the perioperative phase for patients with cancer. This pilot trial aims to explore the feasibility of the proposed intervention, assess patient acceptability and obtain estimates of effect to provide data for sample size calculations.

METHODS AND ANALYSIS

Patients with colorectal cancer and liver metastasis undergoing elective surgery will be recruited for this single-centre, randomised pilot trial with a three-arm design. A total of 54 participants will be randomised at 1:1:1 ratio to one of two intervention groups or a control receiving standard treatment. Those randomised to an intervention group will either receive perioperative virtual reality-based stress reduction exercises twice daily or listen to classical music twice daily. Primary feasibility outcomes are number and proportions of participants recruited, screened, consented and randomised. Furthermore, adherence to the intervention, compliance with the completion of the quality of life questionnaires and feasibility of implementing the trial procedures will be assessed. Secondary clinical outcomes are measurements of the effectiveness of the interventions to inform sample size calculations.

ETHICS AND DISSEMINATION

The study protocol, the patient information and the informed consent form have been approved by the ethics committee of the Ludwigs-Maximilians-University, Munich, Germany (Reference Number: 19-915). Study findings will be submitted for publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

DRKS00020909.

Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: A questionnaire study

Aims

To describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3.

Design

Prospective, explorative two-site follow-up study.

Methods

Patients having selected surgeries from January-July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression.

Results

The proportion of patients presenting with moderate-to-severe anxiety or depression ranged from 5.4%-20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS-Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS-Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery.The four models explained from 43.9%-55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay.

The question of preoperative anxiety and depression in older patients and family protectors

Background

Higher levels of anxiety increase the risks of surgery, including morbidity and mortality. The objectives of this study were to measure anxiety and depression during the preoperative period and to identify the degree of knowledge and concerns of older patients and their family protectors regarding anesthesia, and the causes of these concerns.

Methods

We administered a questionnaire to older patients scheduled to undergo surgery and their family protectors one day prior to the surgery. The questionnaire included tools for quantifying anxiety and depression (Anxiety-Visual Analogue Scale, the Amsterdam Preoperative Anxiety and Information Scale, State-Trait Anxiety Inventory Korean YZ Form, and Short Form Geriatric Depression Scale). We also asked about the concrete causes of anxiety using pre-created forms.

Results

There were 140 older patients and family protectors who participated in the study. The majority of older patients (n = 114, 81.4%) undergoing surgery and their family protectors (n = 114, 81.4%) indicated that they were anxious. Most of the older patients and their family protectors responded that they had insufficient knowledge about anesthesia, and they were mostly worried about failure to awaken following surgery, and postoperative pain. Older patients with higher anxiety scores showed higher depression scores. There were significant differences in depression scores depending on the presence of cohabitating family members.

Conclusions

It is important to remember that older patients with higher depression scores have higher anxiety during the preoperative period.

Sources of distress among patients undergoing surgery for colorectal cancer: a qualitative study

BACKGROUND

Distress is common among cancer and surgical patients and can lead to worse outcomes if untreated. The objective of this study was to explore sources of distress among colorectal cancer patients undergoing surgery.

MATERIALS AND METHODS

This was a qualitative study using in-depth, semistructured, one-on-one interviews in an academic setting. Patients were recruited if they had a pathologically confirmed diagnosis of colon or rectal cancer. Purposive sampling was used to recruit patients who were about to undergo (preoperative), or had recently undergone (postoperative), curative resection for colorectal cancer.

RESULTS

All participants (n = 24) reported experiencing distress during treatment. Participants identified sources of distress preoperatively (negative emotional reaction to diagnosis, distress from preconception of cancer diagnosis, and distress interacting with healthcare system). Sources of distress during in-hospital recovery included negative emotional reaction to having a surgery and negative emotions experienced in the hospital. Postoperative sources of distress included mismatch of expectations and experience of recovery, dealing with distressing physical symptoms and complications after surgery, and distress worrying about recurrence. Participants identified other sources of distress that were not time-specific (distress related to social support network, from disruption of life, and worrying about death).

CONCLUSIONS

Our results highlight a potential role for a comprehensive screening program to identify which patients require assistance with addressing sources of distress during the surgical experience. Understanding how sources of distress may vary by time will help us tailor interventions at different time points of the surgical experience.