Depressive Symptoms Before and After Elective Hysterectomy

Objective: To examine the factors associated with depressive symptoms before and after surgery in women who undergo elective hysterectomy. Design: A secondary analysis of longitudinal data from a prospective cohort study designed to understand chronic postsurgical pain in women. Setting: One acute care hospital in southeastern, Ontario, over a 4-year period (2006-2010). Participants: Three hundred eighty-four (384) English-speaking women, age 18 years or older, who presented for elective hysterectomies. Methods: Data were gathered preoperatively in the same-day admission center and six months postoperatively using validated web-based or mailed questionnaires. Results: Thirty six percent (36%) of participants reported depressive symptoms before surgery, 22% reported symptoms afterwards, 15% reported symptoms at both time points, and 6% developed new onset depressive symptoms postoperatively. Younger (odds ratio [OR] = 2.5, 95% confidence interval [Cl], [1.7, 5.0]) women, those with higher levels of anxiety (state: OR = 8.6, 95% Cl [5.2, 14.0]), or who experienced pain that interfered with their daily functioning (OR = 2.8, 95% Cl [1.7, 4.7]) were more likely to report depressive symptoms prior to hysterectomy. Preoperative pain (OR = 2.0, 95% CI [1.1, 3.6]), trait anxiety (OR = 2.4, 95% Cl [1.2, 4.6]), and depressive symptoms (OR = 3.9, 95% Cl [2.1, 7.5]) increased the risk of depressive symptoms 6 months postoperatively. Conclusion: Young women who exhibit high levels of anxiety and pain and who require a hysterectomy are at risk of experiencing psychological distress prior to and following their surgery.