Post-hysterectomy adaptation: a review and report of two follow-up studies

Patients' expectations of outcome of hysterectomy and alternative treatments for menstrual problems

Patients can influence treatment to the extent of securing surgery in the absence of medical need, but their expectations of effects of surgery are poorly understood. Interviews with 26 patients presenting menstrual problems without confirmed pathology were used to construct a questionnaire to measure expectations of effects of treatment. Principal-components analysis of responses of 200 similar patients identified six discrete areas in which improvement was expected, including general well-being, menstrual function, and physical symptoms. Expectations of harm were nonspecific and unidimensional. Component-based scale scores showed that patients who anticipated hysterectomy expected more benefit, but also more harm, than those anticipating conservative procedures. In study 2, these different expectations were largely replicated in patients who were randomly allocated to provide their expectations of specific procedures. Patients' uniquely positive expectations of hysterectomy may help to explain its frequent use in the absence of pathology.

A prospective study of changes in negative mood states of women undergoing surgical hysterectomy: the relationship to cognitive predisposition and familial support

Levels of anxiety and depression were documented by questionnaire response from a sample of 89 women who were to undergo surgical hysterectomy 3 weeks later. Fifty-four per cent (n = 48) of the sample reported anxiety and 26% (n = 23) reported depression at clinical levels during the preoperative period, with an additional number (n = 16 anxiety; n = 19 depression) at borderline status. Despite an overall significant postoperative reduction of negative mood states, clinical levels of anxiety were found in a substantial minority of women both 2 (24%) and 6 months (31%) after surgery. Levels of depression at these times were respectively 13% and 11% of the sample which provided postoperative information. These data confirm previous reports of high levels of negative mood states in patients referred for surgical hysterectomy. However, analyses of individual profiles of change confirm that there was a beneficial outcome for the large majority of the women, with 83% of those with clinical levels of anxiety showing improved status. Regression analyses indicated that postoperative outcomes with respect to negative affect could be predicted from preoperative status, and the data provide some support for the hypothesis that for a minority of women, negative mood states co-presented with gynecological symptoms may not be attenuated by surgery. Both dispositional resilience and familial cohesiveness were entered as significant variables in regression models examining postoperative status, although they provided only a limited increase to the postoperative variance prediction from measure of preoperative levels of affect. Preoperative mood status was found to be inversely related to an intrapersonal dimension of 'dispositional resilience' and to 'family cohesiveness'. It is suggested that measurement of preoperative mood status to family cohesiveness and dispositional resilience may provide useful adjunctive measures in attempts to identify women at risk of reporting an unsatisfactory surgical outcome.