Psychosomatic medicine, 2015-11, Vol.77 (9), p.993
2015
Details
- Autor(en) / Beteiligte
- Titel
- Presurgical Psychological and Neuroendocrine Predictors of Psychiatric Morbidity After Major Vascular Surgery: A Prospective Longitudinal Study
- Ist Teil von
- Psychosomatic medicine, 2015-11, Vol.77 (9), p.993
- Ort / Verlag
- United States: Lippincott Williams & Wilkins Ovid Technologies
- Erscheinungsjahr
- 2015
- Link zum Volltext
- Quelle
- Applied Social Sciences Index & Abstracts (ASSIA)
- Beschreibungen/Notizen
- Major life stressors, including major surgeries, are often followed by psychiatric symptoms and disorders. Prior retrospective work found abdominal aortic aneurysm (AAA) repair is followed by increased psychiatric morbidity, which may adversely influence physical and functional recovery. Identifying risk factors before surgery, such as dysregulation in stress response systems, might be useful in improving preventative intervention. Two hundred sixteen patients receiving open AAA or aortofemoral bypass surgeries, endovascular AAA repair, or nonsurgical AAA treatment were recruited from two vascular surgery services. Psychiatric symptoms and salivary cortisol measures (waking, 4 PM, and 11 PM, before and after low-dose dexamethasone) were obtained at intake and 3- and 9-month follow-ups. After open surgeries, 18% of patients had new psychiatric disorders, compared with 4% of patients receiving endovascular AAA repair or nonsurgical treatment (odds ratio = 6.0, 95% confidence interval = 1.6-22.1, p = .007). Having a history of major depression predicted the onset of new disorders in surgical patients. Presurgical cortisol levels were associated with both baseline (r = 0.23, p < .05) and 9-month (r = 0.32, p < .01) psychiatric symptoms (cortisol B = 1.0, standard error = 0.48, p < .05, in repeated-measures mixed model). Open AAA repair surgery is prospectively linked to the development of psychiatric morbidity, and history of depression elevates risk. Cortisol measures before surgery are associated with current and future psychological functioning, suggesting potential neurobiological mechanisms that may contribute to vulnerability. These results can help identify surgical patients at risk and point to potential targets for risk reduction interventions.
- Sprache
- Englisch
- Identifikatoren
- ISSN: 0033-3174eISSN: 1534-7796DOI: 10.1097/PSY.0000000000000235Titel-ID: cdi_proquest_journals_1735895066
- Format
- –
- Schlagworte
- Aged, Anastomosis, Surgical - psychology, Aneurysms, Anxiety Disorders - etiology, Aorta, Aorta, Abdominal - surgery, Aortic Aneurysm, Abdominal - complications, Aortic Aneurysm, Abdominal - psychology, Aortic Aneurysm, Abdominal - surgery, Aortic aneurysms, At risk, Cardiovascular system, Cortisol, Depression, Depressive Disorder - blood, Depressive Disorder - complications, Dexamethasone, Dexamethasone - pharmacology, Disease Progression, Disease Susceptibility, Female, Femoral Artery - surgery, Follow-Up Studies, Humans, Hydrocortisone, Hydrocortisone - analysis, Hydrocortisone - secretion, Hypothalamo-Hypophyseal System - physiopathology, Intervention, Interview, Psychological, Male, Mental depression, Mental disorders, Middle Aged, Morbidity, Neurobiology, Patients, Peripheral Arterial Disease - complications, Peripheral Arterial Disease - psychology, Peripheral Arterial Disease - surgery, Pituitary-Adrenal System - physiopathology, Postoperative Complications - epidemiology, Postoperative Complications - psychology, Preoperative Care, Prospective Studies, Psychiatric morbidity, Psychiatric symptoms, Psychiatry, Psychological functioning, Psychosomatic medicine, Recovery, Recovery of function, Risk, Risk Factors, Risk reduction, Saliva - chemistry, Salivary cortisol, Self Report, Severity of Illness Index, Stress Disorders, Post-Traumatic - etiology, Surgery, Vascular disease, Vascular Surgical Procedures - psychology, Vulnerability