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Depression, Anxiety, and Pelvic Floor Symptoms Before and After Surgery for Pelvic Floor Dysfunction

Larouche, Maryse MD, MPH*†; Brotto, Lori A. PhD; Koenig, Nicole A. BA; Lee, Terry PhD§; Cundiff, Geoffrey W. MD‡§; Geoffrion, Roxana MD

Female Pelvic Medicine & Reconstructive Surgery: April 23, 2018 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000582
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Objectives We aimed to explore the correlation between perioperative symptoms of depression and anxiety with pelvic floor symptoms after urogynecologic surgery. Postoperative pain, goal attainment, quality of life, and satisfaction were assessed.

Methods A prospective cohort study of women undergoing inpatient urogynecologic surgery was conducted. Preoperative questionnaires included Beck Depression and Beck Anxiety Inventories, Pain Catastrophizing Scale, Pelvic Floor Distress Inventory, Pelvic Floor Impact Questionnaire, and a detailed goals and perioperative supports questionnaire. Postoperative pain was assessed via the Short-Form McGill Pain Questionnaire. Questionnaires were readministered 6 weeks postoperatively. Descriptive statistics were obtained. Spearman correlation determined the relationship between preoperative and postoperative questionnaire scores. Quantile regression assessed the potential moderating effect of patient characteristics on these relationships.

Results Sixty women (mean age, 58.5 years) were recruited. Fifty-seven (95%) completed follow-up. Most common surgical indication was pelvic organ prolapse (59/60; 98%). Depression and anxiety symptoms were minimal in most women. There was significant median change in preoperative to postoperative scores for Beck Anxiety Inventory (−2.0, P = 0.011), Pelvic Floor Distress Inventory-20 (−69.4, P < 0.001), and Pelvic Floor Impact Questionnaire-7 (−23.8, P = 0.001). Baseline depression and anxiety symptoms were correlated with higher immediate postoperative pain, but not other outcomes. The most common goal, achieved by 47 (92%) of 51, was to reduce condition-specific symptoms. Postoperative depression and anxiety symptoms, and pelvic floor distress and impact were significantly correlated.

Conclusions Baseline depression and anxiety symptoms were not significantly associated with postoperative pelvic floor symptom burden or surgical satisfaction. Bothersome postoperative pelvic floor symptoms were associated with postoperative depressive symptoms.

From the *Department of Obstetrics and Gynecology, McGill University; †Research Institute of the McGill University Health Center, Montreal, Quebec; and ‡Department of Obstetrics and Gynecology and §Center for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, British Columbia, Canada.

Correspondence: Maryse Larouche, MD, MPH, St Mary's Hospital, 3830 Lacombe Ave, Montréal, QC, Canada H3T 1M5. E-mail: maryse.larouche@gmail.com.

Roxana Geoffrion is a preceptor/proctor for Boston Scientific Capio and Obtryx devices. Geoffrey W. Cundiff, Maryse Larouche, Lori Brotto, Terry Lee, and Nicole A. Koenig have no financial conflicts of interest to disclose.

No funding was obtained for this project.

Authors' contributions: M. Larouche contributed to the study design, data collection and management, data analysis, and manuscript writing; L.A. Brotto, concept development, study design, and manuscript editing; N.A. Koenig, study design, data management, and manuscript editing; T. Lee, data analysis and manuscript writing; G.W. Cundiff, concept development and manuscript editing; and R. Geoffrion, concept development, study design, and manuscript editing.

Poster presentation at the Society of Obstetricians and Gynecologists of Canada's Annual Clinical and Scientific Meeting in Vancouver, BC, Canada; June 16, 2016.

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