Pre-operative state anxiety as a mediator of psychological adjustment to and recovery from surgery.

Psychological theories of stress suggest competing hypotheses for the predictive relationship between pre-operative anxiety and post-operative adjustment and recovery. Evidence is presented to assess whether linear or curvilinear (quadratic) relationships account for the association between pre-operative anxiety and post-operative variables. These two hypotheses are tested on two samples of patients undergoing elective minor gynaecological surgery. Multiple regression analyses provided weak support for a linear, but not a curvilinear, relationship between pre-operative anxiety and post-operative anxiety but not with post-operative outcomes other than anxiety such as pain or speed of returning to normal activities. Qualitative data are also presented which examine whether patients who show either low or high levels of pre-operative anxiety differ in the nature of their fears of surgery or their preferred methods of coping with fear and with post-operative pain. No evidence was found to suggest that patients with either high or low levels of pre-operative anxiety differed in appraisal or coping strategies. There was little evidence that the beneficial effects of a special preparatory booklet on post-operative adjustment and recovery were mediated by its influence on state anxiety.