PDF herunterladen
Thorac Cardiovasc Surg 2018; 66(07): 530-536
DOI: 10.1055/s-0037-1604461
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Anxiety and Depression in Patients Undergoing Mitral Valve Surgery: A Prospective Clinical Study

Katrin Botzet
1   Clinic for Cardiovascular Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
,
Hannan Dalyanoglu
1   Clinic for Cardiovascular Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
,
Ralf Schäfer
2   Clinical Institute of Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Düsseldorf, Germany
,
Artur Lichtenberg
1   Clinic for Cardiovascular Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
,
Jochen D. Schipke
3   Research Group Experimental Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
,
Bernhard Korbmacher
1   Clinic for Cardiovascular Surgery, University Hospital Düsseldorf, Düsseldorf, Germany
› Institutsangaben
Weitere Informationen

Publikationsverlauf

17. April 2017

27. Juni 2017

Publikationsdatum:
06. August 2017 (online)

    Lizenzen und Reprints Alle Artikel dieser Rubrik

Abstract

Background Impending cardiac surgery presents an existential experience that may induce psychological trauma. Moreover, quality of life long after successful coronary artery bypass graft surgery (CABG) can be impaired.

Aim The aim of this study was to describe the time course of anxiety and depression in patients undergoing mitral valve surgery and compare it with our earlier results of patients undergoing CABG, a disease that is likely to be related to psychosomatic disorders. We hypothesized that patients undergoing mitral valve surgery can better manage stresses of cardiac surgery than patients undergoing CABG.

Patients and Methods Of 117 patients undergoing mitral valve surgery, 100 patients (22 to 87 years; 53 females) completed the study and were interviewed before (pre), 1 week after (early), and 6 months after (late) surgery. The Hospital Anxiety and Depression Scale (HADS) was employed.

Results The proportion of patients with elevated anxiety scores (AS ≥ 8) was higher than normal (19.8%): pre, 33.0%; early, 28.0%; and was normalized late (18.0%). Similarly, depression scores (DS ≥ 8) were increased: pre, 15.0%; early, 20.0%; and late 14.0%, respectively (normal: 3.2%).

Conclusion Coronary heart disease of CABG patients is presented as a systemic disorder, associated with both higher and postoperatively increased distress levels than in mitral valve patients. Anxiety and depression should be recognized as possible symptoms of psychosomatic disorders necessitating psychotherapeutic intervention to prevent postoperative depression and warrant patient-perceived surgical outcome that is additionally affected by expectations with respect to treatment and individual coping capacities. HADS is recommended to screen for vulnerable patients in the clinical routine, and psychosomatic support should be provided.

Keywords

mitral valve - surgery - anxiety - depression - development
 

  • References

  • 1 Höfling S. Psychologische Vorbereitung auf chirurgische Operationen. In Höfling S. . ed. Angewandte Psychologie im Krankenhaus. Göppingen: Schneider Verlag Hohengehren GmbH; 1994: 99-113
    Google Scholar
  • 2 Santos FS, Velasco IT, Fráguas Jr R. Risk factors for delirium in the elderly after coronary artery bypass graft surgery. Int Psychogeriatr 2004; 16 (02) 175-193
    CrossrefPubMedGoogle Scholar
  • 3 Vaccarino V, Lin ZQ, Kasl SV. , et al. Gender differences in recovery after coronary artery bypass surgery. J Am Coll Cardiol 2003; 41 (02) 307-314
    PubMedGoogle Scholar
  • 4 Oxlad M, Stubberfield J, Stuklis R, Edwards J, Wade TD. Psychological risk factors for increased post-operative length of hospital stay following coronary artery bypass graft surgery. J Behav Med 2006; 29 (02) 179-190
    CrossrefPubMedGoogle Scholar
  • 5 Hoyer J, Eifert GH, Einsle F. , et al. Heart-focused anxiety before and after cardiac surgery. J Psychosom Res 2008; 64 (03) 291-297
    CrossrefPubMedGoogle Scholar
  • 6 Tully PJ, Baker RA, Turnbull DA, Winefield HR, Knight JL. Negative emotions and quality of life six months after cardiac surgery: the dominant role of depression not anxiety symptoms. J Behav Med 2009; 32 (06) 510-522
    CrossrefPubMedGoogle Scholar
  • 7 Mallik S, Krumholz HM, Lin ZQ. , et al. Patients with depressive symptoms have lower health status benefits after coronary artery bypass surgery. Circulation 2005; 111 (03) 271-277
    CrossrefPubMedGoogle Scholar
  • 8 Herrmann-Lingen C. Psychosomatic aspects of chronic heart failure. Nothing but depression? [Article in German]. Herz 2011; 36 (02) 135-140
    CrossrefPubMedGoogle Scholar
  • 9 Kapfhammer HP. The relationship between depression, anxiety and heart disease - a psychosomatic challenge [Article in German]. Psychiatr Danub 2011; 23 (04) 412-424
    PubMedGoogle Scholar
  • 10 Ladwig KH, Lederbogen F, Albus C. , et al. Position paper on the importance of psychosocial factors in cardiology: update 2013. Ger Med Sci 2014; 12: Doc09
    PubMedGoogle Scholar
  • 11 Tully PJ, Cosh SM. Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease: a meta-analysis. J Health Psychol 2013; 18 (12) 1601-1616
    CrossrefPubMedGoogle Scholar
  • 12 Herrmann Ch, Buss U, Snaith RP. HADS-D–Hospital anxiety and depression scale–Deutsche Version, Testdokumentation und Handanweisung. Bern, CH: Verlag Hans Huber; 1993
    Google Scholar
  • 13 Korbmacher B, Ulbrich S, Dalyanoglu H. , et al. Perioperative and long-term development of anxiety and depression in CABG patients. Thorac Cardiovasc Surg 2013; 61 (08) 676-681
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 14 Selye H. The evolution of the stress concept. Stress and cardiovascular disease. Am J Cardiol 1970; 26 (03) 289-299
    CrossrefPubMedGoogle Scholar
  • 15 Selye H. Stress and the general adaptation syndrome. Br Med J 1950; 1 (4667): 1383-1392
    CrossrefPubMedGoogle Scholar
  • 16 Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. an updated literature review. J Psychosom Res 2002; 52 (02) 69-77
    CrossrefPubMedGoogle Scholar
  • 17 Herrmann C. International experiences with the Hospital Anxiety and Depression Scale--a review of validation data and clinical results. J Psychosom Res 1997; 42 (01) 17-41
    CrossrefPubMedGoogle Scholar
  • 18 Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand 1983; 67 (06) 361-370
    CrossrefPubMedGoogle Scholar
  • 19 Al Busaidi ZQ. The concept of somatisation: a cross-cultural perspective. Sultan Qaboos Univ Med J 2010; 10 (02) 180-186
    PubMedGoogle Scholar
  • 20 Dijkstra-Kersten SM, Sitnikova K, van Marwijk HW. , et al. Somatisation as a risk factor for incident depression and anxiety. J Psychosom Res 2015; 79 (06) 614-619
    CrossrefPubMedGoogle Scholar
  • 21 Vieweg WV, Hasnain M, Lesnefsky EJ, Turf EE, Pandurangi AK. Assessing the presence and severity of depression in subjects with comorbid coronary heart disease. Am J Med 2010; 123 (08) 683-690
    CrossrefPubMedGoogle Scholar
  • 22 Crawford JR, Henry JD, Crombie C, Taylor EP. Normative data for the HADS from a large non-clinical sample. Br J Clin Psychol 2001; 40 (Pt 4): 429-434
    CrossrefPubMedGoogle Scholar
  • 23 Gerrits MM, van Marwijk HW, van Oppen P, van der Horst H, Penninx BW. Longitudinal association between pain, and depression and anxiety over four years. J Psychosom Res 2015; 78 (01) 64-70
    CrossrefPubMedGoogle Scholar
  • 24 Wittchen HU, Jacobi F, Klose M, Ryl L. Depressive Erkrankungen. . In: Robert Koch-Institut, ed. Gesundheitsberichterstattung des Bundes Heft 51. Berlin: Bundesministeriums für Gesundheit; 2010
    Google Scholar
  • 25 Logan DE, Rose JB. Is postoperative pain a self-fulfilling prophecy? Expectancy effects on postoperative pain and patient-controlled analgesia use among adolescent surgical patients. J Pediatr Psychol 2005; 30 (02) 187-196
    CrossrefPubMedGoogle Scholar
  • 26 Lebowitz MS, Ahn WK. Emphasizing malleability in the biology of depression: Durable effects on perceived agency and prognostic pessimism. Behav Res Ther 2015; 71: 125-130
    CrossrefPubMedGoogle Scholar
  • 27 Chunta KS. Expectations, anxiety, depression, and physical health status as predictors of recovery in open-heart surgery patients. J Cardiovasc Nurs 2009; 24 (06) 454-464
    CrossrefPubMedGoogle Scholar
  • 28 Grabow L, Buse R. Preoperative anxiety--anxiety about the operation, anxiety about anesthesia, anxiety about pain? [Article in German]. Psychother Psychosom Med Psychol 1990; 40 (07) 255-263
    PubMedGoogle Scholar
  • 29 Rost S, Van Ryckeghem DM, Koval P, Sütterlin S, Vögele C, Crombez G. Affective instability in patients with chronic pain: a diary approach. Pain 2016; 157 (08) 1783-1790
    CrossrefPubMedGoogle Scholar
  • 30 Modica M, Ferratini M, Spezzaferri R, De Maria R, Previtali E, Castiglioni P. Gender differences in illness behavior after cardiac surgery. J Cardiopulm Rehabil Prev 2014; 34 (02) 123-129
    CrossrefPubMedGoogle Scholar