The Association of Clinical, Surgical, and Socio-Psychological Factors with Depression Scores in Cardiothoracic Surgery patients

Introduction: Depressive symptoms pre- and post-operatively are highly prevalent in cardiac surgery patients. In fact, depression is risk factor for mortality in this patient population. However, pre- and post-operatively assessment protocols have not been universally adopted. The objectives of the study were: (1) to assess depression scores longitudinally pre- and post-operatively following discharge and (2) to examine the relationship between depression scores and clinical, surgical, and socio-psychological factors.

Material and Methods: In total, 100 cardiac surgery patients were prospectively enrolled in the study. Depression scores were assessed, using the Center for Epidemiological Study of Depression (CES-D) at pre-operative, hospitalization, 2 weeks and 6 weeks post-discharge visits. Clinical, surgical and socio-psychological predictors of depression scores were examined.

Results and discussion: A total of 100 patients who underwent cardiac surgery participated in our study with an average age of 60.9 years. The depressive scores significantly increased during hospitalization from preoperative levels. At both 2 weeks and 6 weeks post-discharge, the depressive scores decreased significantly as compared to the scores during hospitalization. The percentages of patients who scored 16£ CES-D increased from preoperative (39%) to hospitalization (71%), and decreased gradually at 2 weeks (45%) and 6 weeks (37 %) post discharge. Predictors of high preoperative CES-D scores include diabetes and smoking. Post-operative predictors of high CES-D scores include female gender, EF less than 50%, low economic status, non-participation in cardiac rehabilitation, and high preoperatively CES-D scores.

Conclusion: Patients following cardiac surgery have high depressive scores, suggesting that depression needs to be assessed and addressed. Preoperative screening and management of depression prior to and after surgery may improve outcomes of cardiac surgery patients who have high risk for depression. Further understanding of the components which contribute to high depression scores is required to facilitate clinical intervention.