Research Unit, Centre of Elective Surgery, Regional Hospital of Silkeborg, Falkevej 1-3, Silkeborg, 8600, Denmark; Department of Public Health, Section for Clinical Social Medicine and Rehabilitation, Aarhus University, P.P.Ørumsgade 9-1, Building 1B, Aarhus C, 8000, Denmark.
Department of Public Health, Section for Nursing Science, Aarhus University, BartholinsAlle' 2, Building 1260, room 312 Aarhus C, 8000, Denmark.
Spine J. 2018 Jul;18(7):1272-1285. doi: 10.1016/j.spinee.2018.03.017. Epub 2018 Apr 9.
Symptoms of preoperative anxiety and depression occur in approximately one-third of patients with chronic back pain undergoing surgery. In the last 2 decades, several studies have established that preoperative anxiety and depression are important outcome predictors of greater pain and physical impairments, and lower health-related quality of life in patients undergoing spine surgery. To accommodate symptoms of anxiety and depression and thereby better surgical outcomes, we need to identify factors associated with these symptoms.
We aimed to identify factors associated with symptoms of anxiety and depression in adults both before and after undergoing spinal surgery.
An integrative literature review was carried out.
The independent charity Helsefonden supported this literature review by contributing $45,000 to remunerate a dedicated investigator. A systematic literature search was conducted in PubMed, CINAHL, PsycINFO, Embase, Scopus, Cochrane, and Web of Science. A three-step selection and assessment process was conducted; titles and abstracts of 1,124 articles were skimmed for relevance and of these, 53 articles were found to be of relevance and were read in full. Articles not meeting the inclusion criteria (n=26) were excluded. The 31 articles were critically appraised for methodological validity; 14 of these were synthesized and analyzed using a convergent qualitative design to transform both qualitative and quantitative articles into qualitative findings.
Fourteen studies were included, reporting results based on 4,833 participants, 3,017 men and 1,816 women, whose mean age was approximately 49 years. From these results, we extracted 75 individual findings, which we then divided into five categories of factors associated with anxiety and depression both before and after undergoing spine surgery: pain, information, disability, employment, and mental health.
Five categories of interacting factors that influenced symptoms of anxiety and depression both before and after surgery were identified: pain, lack of information, disability, return to work, and mental health. Information appears to have a regulating effect on anxiety and depression.
大约三分之一接受慢性背痛手术的患者会出现术前焦虑和抑郁症状。在过去的 20 年中，多项研究已经证实，术前焦虑和抑郁是脊柱手术后患者疼痛加剧、身体功能障碍以及健康相关生活质量降低的重要预后预测因素。为了缓解焦虑和抑郁症状，从而改善手术效果，我们需要确定与这些症状相关的因素。
我们旨在确定接受脊柱手术后成人术前和术后出现焦虑和抑郁症状的相关因素。
进行了一项综合文献复习。
独立慈善机构 Helsefonden 为此项文献复习提供了 45,000 美元的资助，用于支付专门研究人员的薪酬。在 PubMed、CINAHL、PsycINFO、Embase、Scopus、Cochrane 和 Web of Science 中进行了系统的文献检索。经过三步筛选和评估过程，对 1,124 篇文章的标题和摘要进行了相关性评估，其中 53 篇文章与研究相关，并进行了全文阅读。有 26 篇文章不符合纳入标准（n=26），被排除在外。对 31 篇文章进行了方法学有效性的批判性评估；其中 14 篇文章采用了聚合定性设计进行综合分析，将定性和定量文章转化为定性发现。
纳入了 14 项研究，报道了 4833 名参与者（3017 名男性和 1816 名女性）的结果，其平均年龄约为 49 岁。从这些结果中，我们提取了 75 个个体发现，将其分为五个类别的与脊柱手术后焦虑和抑郁相关的因素：疼痛、信息、残疾、就业和心理健康。
确定了五个相互作用的类别，这些类别影响了手术前后的焦虑和抑郁症状：疼痛、信息缺乏、残疾、重返工作岗位和心理健康。信息似乎对焦虑和抑郁具有调节作用。
