The course of anxiety and depression in patients undergoing coronary artery bypass graft surgery

Abstract

A semilongitudinal study was designed to follow-up the course of anxiety and depression in patients undergoing coronary artery bypass graft (CABG) surgery. The focus was on possible effects of gender and age on variations in both mean level and interindividual differences over time. At two timepoints before and two after surgery, 217 patients completed self-report questionnaires. Multivariate testing revealed an overall decrease in mean levels of anxiety and depression in the postoperative period but different trends for men and women. Compared with men, women reported more anxiety and depression, both pre- and postoperatively, but showed a relatively stronger decrease in the early postoperative period. Regarding variations in interindividual differences over time, multivariate testing revealed different trends of depression for men and women. Women appeared to be most homogeneous in the early days after surgery, whereas interindividual differences for men showed a stable trend.

Introduction

Although coronary artery bypass graft surgery (CABG) is usually successful in relieving angina, it is experienced as a stressful event by many patients. Increased feelings of anxiety and depression have been reported, both pre- and postoperatively 1, 2, 3, 4, 5, 6, 7, 8, 9. Anxiety is the most dominant feeling, particularly in the preoperative period. Although depression has been observed before surgery, it is more common in the postoperative period 2, 4, 7, 8.

Among preoperative fears are those related to the surgical procedure, loss of control, postoperative pain, and dying [10]. In addition, waiting for surgery has been reported as a main source of concern because of the patient’s fear of suffering a heart attack or of dying prior to surgery 11, 12. Moreover, because of long waiting lists, another source of worry is uncertainty of the exact day of surgery [12]. Patients feel more insecure during this period than on the day prior to surgery, when time remaining can be counted off in fixed units [13] and the patient can prepare psychologically. On the other hand, the day of admission can also be very stressful as patients have to cope with both the stress of hospitalization and the anxiety about the impending surgery [14].

In the days following surgery, some patients react with relief and a decrease in anxiety, whereas others exhibit increased feelings of anxiety and depression 2, 3, 15. Patients may be preoccupied with their discomfort or concerned about the success of surgery 7, 8, 15. Persisting feelings of anxiety and depression in the late postoperative period can be an expression of disappointment with their state of physical health or refer to problems adapting to the changed situation 2, 15. In addition, there may be a strong fear of failure combined with career and family problems [2].

Although some studies reported differences between pre- and postoperative states of anxiety and depression 1, 8, 16, 17, 18, most recent studies have focused on preoperative determinants of postoperative anxiety and depression 1, 5, 6, 9, 15, 16, 19. These prospective studies may facilitate the identification of patients at risk of postoperative anxiety and depression. Yet, information about variations in anxiety and depression over time is still lacking. For instance, there may be specific variations in mean level, starting prior to surgery, until the late postoperative period. Additionally, the extent to which levels vary interindividually may fluctuate over time.

Because gender and age are potentially critical variables in terms of effect on psychological outcome after surgery [20], their influence should be considered with regard to variations in anxiety and depression over time. Only gender differences have already been reported 1, 16, 20, 21, 22, 23, 24, but these findings are rather inconsistent.

The present semilongitudinal study was designed to examine variations in anxiety and depression over time in patients undergoing CABG. The focus was on variations in both mean level and interindividual differences over time. In addition, we examined whether these variations over time differed between men and women, and between three age groups (<55, 55–65, >65 years of age), after controlling for medical factors. Anxiety and depression were assessed prior to surgery, during early convalescence, and in the late postoperative period.