Theunissen Maurice, Peters Madelon L, Schepers Jan, Schoot Dick C, Gramke Hans-Fritz, Marcus Marco A
Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, The Netherlands.
Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands.
Eur J Obstet Gynecol Reprod Biol. 2017 Oct;217:94-100. doi: 10.1016/j.ejogrb.2017.08.017. Epub 2017 Aug 18.
To assess risk and predictive factors for depression and well-being, 3 and 12 months after elective hysterectomy. Secondary objectives were to assess the incidence of depression, level of well-being, and feelings of femininity.
A prospective multicenter cohort study was performed among 419 women, undergoing hysterectomy for benign indication. Data were collected in the week prior to surgery, and in the per- and postoperative period up to the fourth postoperative day and 3 and 12 months after surgery. Sociodemographic variables, baseline health status, psychosocial predictors, and surgery data were assessed. Outcome measures were Center for Epidemiological Studies-Depression scale (CES-D, range 0-60), the 12-item well-being questionnaire energy and positive well-being subscales (range 0-12), and feelings of femininity. Predictor analyses were performed using linear mixed model analyses.
Levels of depression, energy, and positive well-being after hysterectomy were predicted by their corresponding baseline levels (estimate 0.62 p<0.001, 0.39 p<0.001, 0.37 p<0.001, respectively) and baseline pain (0.31 p=0.003, -0.09 p=0.026, -0.10 p=0.008). Postoperative infection reported at 12 months affected CES-D and energy level. Several other gynaecological, psychosocial, or perioperative factors were also predictive for one of the outcomes. Prevalence of depression at baseline, 3 and 12 months was 24%, 19%, and 21%, respectively. In general, well-being scores were slightly higher 3 and 12 months after hysterectomy than at baseline. Feelings of femininity were not negatively affected in 92% of the patients.
Preoperative psychosocial status, perioperative pain, and postoperative infection were found as predictors of psychological outcome after hysterectomy. In the majority of patients we observed small but significant improvements with regard to postoperative depression and well-being, while feelings of femininity were unaffected.
评估择期子宫切除术后3个月和12个月时抑郁和幸福感的风险及预测因素。次要目的是评估抑郁的发生率、幸福感水平和女性特质感受。
对419例因良性指征接受子宫切除术的女性进行了一项前瞻性多中心队列研究。在手术前一周、手术期间及术后直至术后第四天以及术后3个月和12个月收集数据。评估了社会人口统计学变量、基线健康状况、心理社会预测因素和手术数据。结局指标为流行病学研究中心抑郁量表（CES-D，范围0 - 60）、12项幸福感问卷中的精力和积极幸福感子量表（范围0 - 12）以及女性特质感受。使用线性混合模型分析进行预测因素分析。
子宫切除术后的抑郁、精力和积极幸福感水平可由其相应的基线水平（估计值分别为0.62 p<0.001、0.39 p<0.001、0.37 p<0.001）和基线疼痛（0.31 p = 0.003、 - 0.09 p = 0.026、 - 0.10 p = 0.008）预测。12个月时报告的术后感染影响CES-D和精力水平。其他一些妇科、心理社会或围手术期因素也可预测其中一项结局。基线、3个月和12个月时抑郁的患病率分别为24%、19%和21%。总体而言，子宫切除术后3个月和12个月时的幸福感得分略高于基线。92%的患者女性特质感受未受到负面影响。
术前心理社会状态、围手术期疼痛和术后感染被发现是子宫切除术后心理结局的预测因素。在大多数患者中，我们观察到术后抑郁和幸福感有虽小但显著的改善，而女性特质感受未受影响。
