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Year : 2018 | Volume : 6 | Issue : 2 | Page : 70 - 73  


Original Articles
Psycho-social profile of patients with depression and anxiety undergoing elective surgery

K. Harish Chandra Reddy

Assistant Professor, Department of Psychiatry, Malla Reddy Institute of Medical Sciences, Suraram, Hyderabad, Telangana, India

*Corresponding Author:

Email: dr_harishreddy@yahoo.com

Abstract:

Background: Anxiety is common among patients who are posted for surgery. It is important to study the psycho-social profile of the patients. This knowledge will help plan things pre operatively which will be helpful to reduce anxiety and other psychiatric problems among patients who are undergoing for elective surgery

Objective: To study psycho-social profile of patients with depression and anxiety undergoing elective surgery.

Methods: Present study was a hospital based cross sectional study carried out among 80 eligible patients who were posted for orthopedic surgery in the orthopedic ward. Detailed history, clinical examination and assessment were carried out.

Results: Majority (36%) were in the age group of 31-45 yrs. There were 61% males. 61% were from rural background. 79% were married. 94% patients were Hindu. 70% were 60% were from Middle socio economic status. 30% patients were with no educational background. 35% patients were those whose occupation was agriculture. 67% patients were those who lived with their spouse and children. 54% patients were those whose monthly family income was more than Rs. 2000/-.

Conclusion: Maximum patients were having a better background and pre operative counseling was needed for them. Pre operative counseling was useful to reduce the anxiety and restlessness in majority of the patients.

Key words: Anxiety, counseling, profile

Introduction:

Anxiety is common among patients who are posted for surgery. Patient is worried about his health before, during and after surgery. He is uncertain about the post surgery outcome, what kind of surgery will be done on him, how the anesthesia will be given and will there be any side effects, whether he will have discomfort after surgery and if yes how much and how long, persistence of pain, whether he will be able to do his duties normally or not and if yes how much time it would take for that, whether he will become dependent on others, whether he will survive the operation or not etc. So a variety of and large number of questions trouble him. If he was having any previous psychiatric illness, then these worries add on to the pre existing illness and can lead to mental break down. Thus if the patient is more nervous or anxious, then it can result into postoperative psychological trauma. There is increased pain and the hospital stay may be increased. These things affect recovery of the patient negatively and increase the anesthetic induction. It will also decrease the satisfaction of the patient about the hospital. Thus efforts are required to reduce the anxiety before the surgery to have better outcome. 1

Thus to reduce anxiety before surgery, it is important that the patient must be told about the detailed procedure. Otherwise it can affect the informed consent process and it will also affect the decision of the patient undergoing operation. The risk assessment must not be misleading. Otherwise it gives rise to clinical anxiety. Hence proper identification and correction of this will minimize the anxiety among patients undergoing surgery. 2

Studies have pointed out that 30-70% of patients developed some sort of psychiatric health problem. A study by Sarwer found that the rates of anxiety and other types of psychiatric disorders were more among patients who underwent cosmetic surgery. 3

Some say nursing staff should undertake pre operative counseling for patients to reduce anxiety and other psychiatric problems among those who undergo surgery. This concept is challenging. If the waiting time is more for surgery, it may lead to more incidence of anxiety and other psychiatric problems. If the waiting time is not at all given except in emergency situations i.e. for elective surgeries, then also the occurrence of anxiety and other psychiatric illnesses post operatively are more. These groups of patients will need more amount of pain killers and other drugs as they will be restless and more anxious. They will seek more attention and time of the health care workers. 4

Considering the above facts, it is important to study the psycho-social profile of the patients. This knowledge will help plan things pre operatively which will be helpful to reduce anxiety and other psychiatric problems among patients who are undergoing for elective surgery. Hence present study was undertaken to study psycho-social profile of patients with depression and anxiety undergoing elective surgery.

Methods:

Present study was a hospital based cross sectional study carried out among 80 eligible patients who were posted for orthopedic surgery in the orthopedic ward. Detailed history, clinical examination and assessment were carried out.

Institutional Ethics Committee permission was taken before the start of the study. Individual patient informed consent was also obtained from each and every patient before including them in the present study.

At the end of the study period, 80 patients were found to be eligible considering all the study criteria like their willingness to participate in the present study. Only those patients who were above the age of 16 years or of 16 years of age, only those who were undergoing surgery in the orthopedic department, only those who were willing to participate in the present study were included in the present study. Those who have not completed 15 years of age were not included in the present study. Those patients who were found to have serious complications, or those patients who could not give their consent to participate in the present study, or those patients who were seriously ill at the time of data collection, or those patients who were unable to express their views or those patients who were bed ridden were not included in the present study.

The data was collected in the pre designed, pre tested, semi structured questionnaire. Detailed history like Age (year), Sex, Residence, Marital status, Religion, Type of family, Social class, Education status, Occupation, Living situation, Family income (INR), Social support and addictions like alcohol and smoking was enquired into.

The data was entered in the computer office program. The data was analyzed using proportions.

Results:

Table 1: Socio-demographic distribution of study subjects

Variable

Number

Percentage

Age (year)

16-30

24

30

31-45

29

36

46-60

11

14

61-75

16

20

Sex

Male

49

61

Female

31

39

Residence

Urban

31

39

Rural

49

61

Marital status

Married

63

79

Unmarried

15

19

Widowed

02

02

Religion

Hindu

75

94

Muslim

05

06

Type of family

Nuclear

56

70

Joint

24

30

Social class

Lower

23

29

Middle

48

60

Upper

09

11

Education status

Illiterate

24

30

Primary

20

25

SSC

17

21

Intermediate

03

04

Degree

15

19

Professional

01

01

Occupation

Full time

16

20

Part time

08

10

Unemployed

11

14

Housewife

11

14

Agriculture

28

35

Labor

06

07

Living situation

Alone

02

03

With spouse

54

67

With parents

17

21

Family income (INR)

500-1000

01

01

1000-1500

01

01

1500-2000

35

44

> 2000

43

54

Social support

Parents

44

55

Relatives

30

37

No support

06

08

The study sample contained a majority of 36% patients in the age group of 31-45 yrs and the least of 14% in the age group 46-60 as shown in table. The study sample contained 61% male patients and 39% female patients. The study sample contained 61% patients coming from rural background and 39% coming from urban background.

The study sample contained 79% married patients, 19% unmarried patients and 2% widowed patients. The study sample contained a majority of 94% patients who were Hindu and 6% patients were Muslim. The study sample contained 70% patients coming from nuclear family type and 30% patients coming from joint family. The study sample contained majority of 60% patients coming from Middle socio economic status, 29% from lower SES and 11% from upper SES. The study sample contained 30% patients with no educational background, 25% with primary education, 21% with SSC, 19% with Degree and only 1 patient with Professional background. The study sample contained 35% patients whose occupation was agriculture, 20% were employed full time (driver, shop owner, job holder etc.), 14% were unemployed (students, job seekers) and 7% were daily wage labor. The study sample contained 67% patients who lived with their spouse and children and only 3% who lived alone. The study sample contained majority of 54% patients whose monthly family income was more than Rs. 2000/- and 1 % each whose family income per month was between Rs. 500-1000/- and Rs. 1000-1500/- The study sample contained 55% of patients with parents as their social support and 8% patients with no social support.

Table 2: Distribution of study subjects as per their addictions

Addictions

Number

Percentage

Alcohol

17

21

Smoking

02

03

Multiple

04

05

None

57

71

Table 2 shows distribution of study subjects as per their addictions. The study sample contained 21% patients having habit of alcohol use, 3% patients with smoking habit and 5% patients with both alcohol and smoking habit.

Discussion:

Majority (36%) were in the age group of 31-45 yrs. There were 61% males. 61% were from rural background. 79% were married. 94% patients were Hindu. 70% were 60% were from Middle socio economic status. 30% patients were with no educational background. 35% patients were those whose occupation was agriculture. 67% patients were those who lived with their spouse and children. 54% patients were those whose monthly family income was more than Rs. 2000/-. The study sample contained 21% patients having habit of alcohol use, 3% patients with smoking habit and 5% patients with both alcohol and smoking habit.

Knowles SR et al 5 studied relation between perception of illness and disease activity. They found that disease activity was directly related with the perception of illness. They also noted that the perception of illness was significantly associated with anxiety and depression. They also observed that depression and anxiety were significantly associated with emotional coping strategies. Thus they finally concluded and proved the relationship between factors like perception of illness, disease activity, anxiety, depression and strategies of coping. Thus the authors want that all patients undergoing any kind of surgery should be give psychological support.

Kumar M et al 6 found that anxiety was more in females, among those with ASA grade II, among those patients who underwent surgery in Gynecology department. They also noted that the patients who received midazolam, showed significant reduction in the anxiety levels before surgery. They concluded that anxiety before surgery is an important problem for anesthesiologists. Hence midazolam is helpful in reducing anxiety before surgery.

Knowles SR et al 7 used the structural equation modeling. In this the authors found that, stoma specific quality of life was influenced directly by anxiety, self efficacy and depression. The authors stated that in order to improve the quality of life of patients, the interventions of psychological nature should be targeted towards the process of psychological nature and then only it will be useful. This will help to boost up the confidence of the patient and reduce the levels of anxiety and depression. This will also help to improve the quality of life of patients.

Latif A et al 8 studied 6624 patients. They found that the mean age was 36.75 years. The females were more than males. The pre operative incidence of anxiety was 45.9% which reduced to 32% three weeks after emergency surgery. But the pre operative incidence of anxiety was 10.9% which increased to 30.9% after elective surgery. Hence as we stated earlier, giving time to patients before surgery increases anxiety levels among them. The authors found that in emergency surgery, the anxiety levels dropped down but in elective surgeries, the anxiety levels increased post operatively. But in case of depression, the authors reported that it increased significantly in both types of surgeries.

Knowles SR et al 9 carried out a study to find relationship between morbidity of psychological nature and health status. They found that post operatively the surgery did not influenced the health status but if influenced the perception of illness even after several months. They also noted that depression was affected by perception of illness and other factors. They also observed that anxiety was affected by only perception of illness. Thus the authors concluded that this study gave a very good insight of processes of psychological nature.

Nickinson RS et al 10 found that post surgery 17 patients developed anxiety. But they could not find any association of any factors with anxiety. Depression was found in 50% of cases after surgery. Depression was more among females as compared to males. Females were 3.5 times more likely to develop depression as compared to males. Depression was 3.9 times more among those who underwent arthroplasty than those who did not. But operation site had no significant relation with depression. Similarly anesthetic method and age were also unrelated to depression. Depressed patients stayed for five days more than the none depressed ones. Thus they concluded that depression after surgery was common among patients undergoing bone surgeries. Thus the authors emphasized the need for patients counseling before and after surgery.

Knowles SR et al 11 studied coping strategies, perception of illness with morbidity of psychological nature. Thus they concluded that depression and anxiety were dependent upon to some extent on the perception of illness. They also stressed that patients should receive pre operative and post operative interventions in the form of psychological counseling to boost up their confidence. This will help reduce the incidence of psychological morbidity among them.

Galanakis P et al 12 observed that the incidence of post operative acute confusional state (ACS) was 23.8%. It was 14.7% among those who underwent replacement of hip joint and it was 40.5% among those who underwent fracture of hip. This occurred more commonly 2-5 days after surgery. The important risk factors for ACS were increasing age, previous history of impairment of cognitive functions, depression, low levels of literacy, and abnormal levels of sodium before surgery. On univariate analysis, they found that other risk factors were impairment of vision, impairment of hearing, living away from home, other associated morbidities, previous history of use of psychotropic drugs, and leucocytosis. Thus the authors concluded that ACS was a common health problem among old age patients who underwent surgery of hip.

Knowles SR et al 13 studied association between improper perception of illness with psychiatric morbidity and found that if the perception of illness was poor then it was a predominant risk factor for depression, anxiety. The authors concluded that the prevalence of co-morbidity of psychological origin was more among patients having Crohns disease and a stoma. Improper perception of illness was associated with psychiatric morbidity.

Conclusion:

Maximum patients were having a better background and pre operative counseling was needed for them. Pre operative counseling was useful to reduce the anxiety and restlessness in majority of the patients.

References:

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