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Aspects of Cardiothoracic Anaesthesia

Depression and anxiety after cardiac surgery: second year follow up: 096

Székely, A.; Benkö, E.1; Till, J.; Mészáros, R.

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European Journal of Anaesthesiology: June 2004 - Volume 21 - Issue - p 20

Introduction: Depression and anxiety play important roles in the immediate postoperative period of patients after cardiac surgery [1]. The aim of our study was to investigate long-term influence of these mood disorders.

Method: Following Ethic Committee approval 193 patients were prospectively studied between May 2000 and July 2001. Depression and anxiety scores were measured by pure mail survey before surgery, 6 weeks, 6 months, one and two years after discharge from the hospital. Beck depression Inventory Test, based on cognitive behaviour theory and Spielberger state-trait anxiety inventory test (STAIs and STAIt) were used. The following factors were considered and compared with the follow-up scores: age, gender, type of surgery, marital state, education, preoperative disorders. Additional data collected were: neuropsychiatric disorders, hospitalization, cardiovascular and non-cardiovascular events and death after discharge. Statistical analysis was performed with simple and multiple logistic regressions.

Results: 98 patients responded. During the last year 3 patients died, the overall 2nd year (July 2003) mortality of the study group was 8.2%. The mean BDI score was 8.9 (range: 0-30), 29 patients had mild depressive symptoms (BDI: 10-20), and 9 patients had major depressive problems (BDI: >20). The mean anxiety score was 40.3 (range: 20-71), and 47 patients fell above the anxiety level. (STAIs and STAIt above 40 points are abnormal). According to the results of multiple regression, 2nd year BDI scores correlated with neuropsychiatric disorders (OR: 7.6; P 0.01) and with arrhythmia (OR: 7.5; P 0.01). Anxiety scores were high among patients, who were hospitalized with angina (OR: 12.7; P 0.004) and with arrhythmia (OR: 5.2; P 0.04). 14 responders showed worsened BDI values, and it was correlated with new hospitalization because of angina (OR: 8.7; P 0.007). Increase in the annual anxiety scores occurred less frequently in educated patients (OR: 0 1; P 0.02), but more frequently in patients who had new developed of arrhythmia (OR: 10.2; P 0.05).

Conclusions: Our 2nd year results of the follow up data indicate that depression and anxiety are well-recognized independent cardiovascular risk factors, which strongly influence the long-term medical outcome.

References:

1 Pignay-Demaria V, Lesperance F, Demaria RG, et al. Depression and anxiety and outcomes of coronary artery bypass surgery. Ann Thorac Surg 2003; 75: 314-321.
2 Spielberger CD, Gorsuch RL, Lushene RE. Manual for state-trait anxiety inventory. Arch Gen Psych 1961; 4: 561-571.
    © 2004 European Society of Anaesthesiology