Patron Elisabetta, Messerotti Benvenuti Simone, Palomba Daniela
Department of General Psychology, University of Padova, Italy.
Department of General Psychology, University of Padova, Italy.
Psychosomatics. 2014 May-Jun;55(3):261-71. doi: 10.1016/j.psym.2013.12.011. Epub 2013 Dec 23.
Depression is commonly reported in patients after cardiac surgery and increases the risk of postoperative cardiac morbidity or mortality or both. Although preoperative depression has been implicated as the strongest predictor of depression after surgery, the characteristics thought to influence reactive or persistent depression have been poorly investigated in cardiac surgery patients.
Therefore, the main aim of this study was to examine whether pre-existing depression rather than perioperative variables may predict postoperative reactive or persistent depression.
Overall, 96 patients completed a psychologic evaluation, including the Center for Epidemiologic Studies of Depression scale and the State and Trait Anxiety Inventory for depression and anxiety, respectively, before surgery and at 3-month follow-up.
A total of 27 (28%) and 24 (25%) patients had depression preoperatively and at 3-month follow-up, respectively. Postoperative depression was predicted by preoperative scores in Center for Epidemiologic Studies of Depression scale (β = 0.29, p < 0.05) and European System for Cardiac Operative Risk Evaluation (β = 0.22, p < 0.04), but not by procedure-related variables (p > 0.75). Specifically, patients with reactive depression showed greater European System for Cardiac Operative Risk Evaluation than those without depression (p < 0.05), whereas patients with persistent depression had greater preoperative Center for Epidemiologic Studies of Depression scores than those whose depression improved after surgery (p < 0.01).
The severity of pre-existing depression and biomedical risk factors can be markers of depression-related risk 3 months after cardiac surgery in patients with persistent and reactive depression, respectively. An integrated psychologic and biomedical evaluation is essential to anticipate which patients are likely to show depression after cardiac surgery.
心脏手术后患者中普遍存在抑郁情况，且会增加术后心脏发病或死亡风险，或两者兼而有之。尽管术前抑郁被认为是术后抑郁最强的预测因素，但对于心脏手术患者中影响反应性或持续性抑郁的特征研究较少。
因此，本研究的主要目的是探讨术前存在的抑郁而非围手术期变量是否可预测术后反应性或持续性抑郁。
总体而言，96例患者在手术前及术后3个月随访时完成了心理评估，包括流行病学研究中心抑郁量表以及分别用于评估抑郁和焦虑的状态-特质焦虑量表。
术前和术后3个月随访时分别有27例（28%）和24例（25%）患者存在抑郁。术后抑郁可通过流行病学研究中心抑郁量表术前评分（β = 0.29，p < 0.05）和欧洲心脏手术风险评估系统（β = 0.22，p < 0.04）预测，但不能通过与手术相关的变量预测（p > 0.75）。具体而言，反应性抑郁患者的欧洲心脏手术风险评估系统评分高于无抑郁患者（p < 0.05），而持续性抑郁患者术前流行病学研究中心抑郁量表评分高于术后抑郁改善的患者（p < 0.01）。
术前存在的抑郁严重程度和生物医学风险因素分别可作为持续性和反应性抑郁患者心脏手术后3个月抑郁相关风险的标志物。综合心理和生物医学评估对于预测哪些患者心脏手术后可能出现抑郁至关重要。
