Saskia Boeke

PREDICTION OF QUALITY OF LIFE AFTER CORONARY ARTERY BYPASS GRAFT SURGERY :A REVIEW AND EVALUATION OF MULTIPLE, RECENT STUDIES

Objective To review studies predicting psychosocial outcome after coronary artery bypass graft surgery (CABG). Methods: Seventeen prospective studies, appearing in the MEDLINE and PsycLIT data bases between 1986 and 1996, were reviewed regarding objectives, methodological issues, results, and clinical relevance. Results: All studies reported that psychological factors had predictive value. In particular, preoperative anxiety and depression predicted postoperative psychological maladjustment; social support, preoperative feelings of control, denial, and optimism contributed to psychological adjustment. Conclusions: Many specific psychological outcomes seem to be best predicted by preoperative assessment of functions in that specific area, especially in the case of anxiety and depression. Furthermore, personality factors including denial, optimism, control, and the need for support appear to be predictors of psychological outcome. Appropriate identification of predictive factors might improve the development of individually tailored interventions for patients at risk of postoperative psychological problems.

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

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.

Prediction of postoperative pain and duration of hospitalization using two anxiety measures

&NA; This study examined the extent to which measures of anxiety could predict pain and the length of hospitalization following surgery in 111 patients with gallstones over and above what could be predicted on the basis of biographical and medical status variables. Self‐reported pain on the third day postoperative could hardly be explained by the variables measured. Preoperative anxiety did not increase the value of the prediction. Age, type of surgery, cystitis and wound infection explained a significant proportion of the variance in postoperative hospital stay. Over and above these variables, A‐state on the third postoperative day and also A‐state and specific anxiety measured 1 day before surgery exerted a significant increase on the values of prediction of the length of postoperative hospitalization.

The influence of psychological variables on postoperative anxiety and physical complaints in patients undergoing lumbar surgery

Abstract Previous research has indicated that postoperative distress is influenced by diverse biographic, medical and psychological variables, such as personality, coping behaviours and anxiety. The influence of state variables, apart from anxiety and coping behaviour, has received scant attention. Furthermore, the influence of coping behaviour has remained unclear. The present study investigated coping behaviour and indications of physical distress, i.e., preoperative fatigue, leg pain and back pain, besides preoperative anxiety, as predictors of postoperative anxiety and physical complaints in 126 patients undergoing lumbar surgery. Preoperative anxiety and leg pain independently predicted more postoperative anxiety beyond the influence of age, sex and medical variables. Preoperative anxiety and fatigue independently predicted more postoperative physical complaints. No associations were found between the coping behaviours and the postoperative variables. The implications of these results are discussed in relation to intervention strategies aimed at diminishing the stress of surgery.

Psychological and Somatic Factors in Patients Undergoing Coronary Artery Bypass Graft Surgery: Towards Building a Psychological Framework

The present study explored the relationships between psychological and somatic factors in patients undergoing Coronary Artery Bypass Graft surgery (CABG). The data-analysis of previous work was extended by adding somatic factors, including feelings of disability, somatic complaints and fatigue. The focus was on their relationships with psychological factors, including anxiety, depression and neuroticism. Prior to surgery and six months postoperatively, 217 patients completed self-report questionnaires. Using the method of structural equation modeling (SEM), the structure of relationships between the somatic, psychological and background factors (i.e., gender, age and medical factors) was explored. A model was developed providing a good fit and accounting for a substantial amount of variance. The structure of relationships revealed that somatic factors lead to anxiety and depression in the preoperative period, whereas anxiety and depression lead to somatic factors in the postoperative period. The structure further strengthened the key position of neuroticism and its overall negative prognostic implications.

PREOPERATIVE EXPECTATIONS OF PAIN AND RECOVERY IN RELATION TO POSTOPERATIVE DISAPPOINTMENT IN PATIENTS UNDERGOING LUMBAR SURGERY

OBJECTIVES In groups of lumbar surgery patients who had different expectations about postoperative pain and recovery, this study investigated disappointment three days and three months after surgery. Our hypothesis was that patients who did not expect any postoperative pain and who expected a fast rate of recovery were at risk of becoming disappointed. METHODS One day before surgery, 120 patients who underwent lumbar surgery were interviewed about their expectations regarding postoperative pain, rate of recovery, and return to work. Levels of postoperative pain and disappointment were measured three days and three months postoperatively. RESULTS Patients who did not expect to have any postoperative pain reported significantly less disappointment three days and three months after surgery than did patients who expected to have postoperative pain. No significant differences were found in postoperative disappointment between the groups with different expectations regarding the rate of recovery or the return to work. CONCLUSION Contrary to our hypothesis, the results suggest that patients who do not expect to experience any postoperative pain will be less disappointed after surgery than patients who expect to be in pain. Implications for the theory of mental preparation and for preoperative intervention strategies aimed at diminishing the stress of surgery are discussed.

A structural modeling analysis of anxiety and depression in patients undergoing coronary artery bypass graft surgery: A model generating approach

The present study is a longitudinal study designed to explore structural relationships between anxiety, depression, personality, and background factors (e.g., gender, age, and complicated medical characteristics) in patients undergoing coronary artery bypass graft (CABG) surgery. At two timepoints before and two after CABG, 217 patients completed self-report questionnaires. To explore structural relationships, the structural equation modeling (SEM) method was applied. Using the model-generating approach, a model was developed, providing a good fit. The structural relationships revealed, in particular, the key position of neuroticism, which was related to both pre- and postoperative anxiety and depression. Relationships between anxiety and depression over time, both intra- and interrelationships, were relatively weak. Relationships between anxiety and depression at the same points in time were relatively strong, with preoperative depression leading to preoperative anxiety, and postoperative anxiety leading to postoperative depression. To provide a useful framework for development of intervention strategies, further research is needed to evaluate the plausibility of the final structural model.

Psychological variables as predictors of the length of post-operative hospitalization

The extent to which measures of anxiety and personality characteristics, which had been assessed preoperatively, could predict the length of hospital stay following surgery, above and beyond what could be predicted on the basis of biographical, medical-status and post-operative anxiety variables, was examined in 58 patients with gall-bladder disease. Hierarchical multiple regression analysis revealed that gender, previous operations, complications and State Anxiety (A-State) measured on the third day post-operatively, jointly explained a significant proportion of the variance in the length of hospitalization. Neither preoperative anxiety measures nor personality characteristics had any significant incremental value in the prediction.

A revaluation of the adaptiveness of avoidant and vigilant coping with surgery

Abstract It has been assumed that an avoidant coping style is less adaptive in patients coping with surgery than a vigilant coping style. Empirical evidence, however, has indicated the contrary. This article, therefore, revaluated the adaptiveness of these coping styles. A review of the literature yielded three conditions of the situation that determine the adaptiveness of coping: controllability of the situation, time-reference and interpretational set. Problem-focused coping, vigilance, active coping and monitoring seem to be more adaptive in controllable situations; emotion-focused coping, avoidance, blunting and passive coping more adaptive when little control is possible. For short-term adaptation, avoidance seems the more adaptive strategy, whereas in the long run vigilance is a better strategy. Regarding interpretational set, avoidance seems more adaptive when patients have to cope with the emotional value of the event; vigilance seems more adaptive when coping with sensory elements of the event. I...

AGREEMENT FOR SURGICAL PATIENTS ON TWO SITUATIONS FOR THE TRAIT ANXIETY INVENTORY

According to Spielberger (5). trait anxiety (A-Trait) refers to relatively stable individual differences in anxiety proneness, i.e., to differences in the disposition to perceive a wide range of stimulus situations as threatening and in the tendency to respond to such threats with state anxiety (A-State) reactions. A-Trait should not be influenced by situational stress. Consistent with this assumption, it has been found that A-Trait scores on the State-Trait Anxiety Inventory (5) are not affected by the stress of surgery