This three-month prospective study aimed i) to examine changes in anxiety-depression levels following sternotomy and; ii) to determine whether demographic, co-morbidities and/or pre, peri- and post-operative factors are associated with development of Hospital Anxiety and Depression Scale(HADS)
This study was conducted on 120 adult patients who underwent elective median sternotomy at Hospital Canselor Tuanku Muhriz. The Hospital Anxiety and Depression Scale (HADS) was administered to participants at pre-, post-, 6 weeks and 3 months post cardiac surgery to measure anxiety (HADS-A) and depression (HADS-D) levels. The changes in anxiety and depression across four-time points were analysed with repeated measures analysis of variance (ANOVA). Independent T test were used to determine any significant change in the HADS score, demographic data and other measures (functional independence the Modified Iowa Level of Assistance(mILOA) and health related quality of life(HRQoL)-the EuroQual QOL(EQ-5L-5D); World Health Organisation Disability Assessment Schedule version 2(WHODAS V2). Logistic regression was to use to predict factors that is associated with development of HADS.
The proportions of participants who had anxiety and depression pre-operative median sternotomy were 26.5% and 17.7%, respectively. At 3 months, anxiety was further reduced to 6.2% and depression was 3.5%. The overall changes in anxiety and depression scores across four time points were significant with p0.001. There were significant different with HADS-D and mILOA(MD -4.7, 95% -9.12 to -0.22); EQ-5L-5D(MD 0.1, 95% CI 0.4 to 0.18) and WHODAS V2(MD -3.7,95% CI -6.51 to 0.97) and re-sternotomy(p. Likewise, the HADS-A was significantly associated with NRP(MD-.0.8, 95%CI -1.8 TO -.0.0), WHODAS V2(MD -5.3, 95%CI 1.8 to -9.0) and EQ-5L-5D(MD12.7,95% CI 3.7 -21.6). Further analysis of logistic regression indicates those with re-sternotomy are two times more likely associated with depression(OR 2.1, 95% CI 0.846-79.4). There were no statistically different found for other factors.
There were high proportions of anxiety and depression among patients who underwent cardiac surgery. However, the anxiety and depression levels would decline over time with notable indication that re-sternotomy are two times more likely associated with depression. The results of this study offer insight into the importance of perioperative psychological intervention programmes for this patient group to improve surgical experience.
The study indicated that assessment of psychosocial factors is a prevalent following median sternotomy. Ongoing assessment of anxiety and depression could help in pain, mobility and health related quality of life in patients after median sternotomy. Therefore, the assessment of preoperative well-being should be integrated in routine care in order to identify and support patients with higher levels of anxiety and depression following median sternotomy
Anxiety and Depression
Mobility and Health Related Quality Of Life
