Depression Symptoms Are Associated with Poor Functional Status Among Operative Spinal Deformity Patients

Lafage, Renaud; Ang, Bryan; Schwab, Frank; Kim, Hee Jin; Smith, Justin S.; Shaffrey, Christopher I.; Burton, Douglas C.; Ames, Christopher P.; Hostin, Richard A.; Bess, Shay; Klineberg, Eric O.; Passias, Peter G.; Lafage, Virginie

doi:10.1097/brs.0000000000003886

Cited by 11 publications

(8 citation statements)

References 27 publications

(26 reference statements)

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“…After removing duplicates, 3813 articles were screened, leaving 207 for full-text review. Among these studies, 44 met the eligibility criteria; each study is described in eTable 5 in Supplement 1 . Overall, 21 452 patients were included, of whom there were 11 747 females (55%) and 9705 males (45%) with a mean (SD) age of 57 (8) years.…”

Section: Resultsmentioning

confidence: 99%

Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

Javeed,

Benedict,

Yakdan

et al. 2024

JAMA Netw Open

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ImportanceComorbid depression is common among patients with degenerative lumbar spine disease. Although a well-researched topic, the evidence of the role of depression in spine surgery outcomes remains inconclusive.ObjectiveTo investigate the association between preoperative depression and patient-reported outcome measures (PROMs) after lumbar spine surgery.Data SourcesA systematic search of PubMed, Cochrane Database of Systematic Reviews, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov was performed from database inception to September 14, 2023.Study SelectionIncluded studies involved adults undergoing lumbar spine surgery and compared PROMs in patients with vs those without depression. Studies evaluating the correlation between preoperative depression and disease severity were also included.Data Extraction and SynthesisAll data were independently extracted by 2 authors and independently verified by a third author. Study quality was assessed using Newcastle-Ottawa Scale. Random-effects meta-analysis was used to synthesize data, and I2 was used to assess heterogeneity. Metaregression was performed to identify factors explaining the heterogeneity.Main Outcomes and MeasuresThe primary outcome was the standardized mean difference (SMD) of change from preoperative baseline to postoperative follow-up in PROMs of disability, pain, and physical function for patients with vs without depression. Secondary outcomes were preoperative and postoperative differences in absolute disease severity for these 2 patient populations.ResultsOf the 8459 articles identified, 44 were included in the analysis. These studies involved 21 452 patients with a mean (SD) age of 57 (8) years and included 11 747 females (55%). Among these studies, the median (range) follow-up duration was 12 (6-120) months. The pooled estimates of disability, pain, and physical function showed that patients with depression experienced a greater magnitude of improvement compared with patients without depression, but this difference was not significant (SMD, 0.04 [95% CI, −0.02 to 0.10]; I2 = 75%; P = .21). Nonetheless, patients with depression presented with worse preoperative disease severity in disability, pain, and physical function (SMD, −0.52 [95% CI, −0.62 to −0.41]; I2 = 89%; P &lt; .001), which remained worse postoperatively (SMD, −0.52 [95% CI, −0.75 to −0.28]; I2 = 98%; P &lt; .001). There was no significant correlation between depression severity and the primary outcome. A multivariable metaregression analysis suggested that age, sex (male to female ratio), percentage of comorbidities, and follow-up attrition were significant sources of variance.Conclusions and RelevanceResults of this systematic review and meta-analysis suggested that, although patients with depression had worse disease severity both before and after surgery compared with patients without depression, they had significant potential for recovery in disability, pain, and physical function. Further investigations are needed to examine the association between spine-related disability and depression as well as the role of perioperative mental health treatments.

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Section: Resultsmentioning

confidence: 99%

Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

Javeed,

Benedict,

Yakdan

et al. 2024

JAMA Netw Open

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“…In this study, HADS scores of patients with degenerative cervical myelopathy improved postoperatively. Although it is still controversial, [8][9][10]15,18,19 many previous studies had investigated the relationship between preoperative mental state and postoperative surgical outcomes in spine surgery. For example, postoperative axial pain was reported to be related with the mental state as measured by MCS of SF-36.…”

Section: Discussionmentioning

confidence: 99%

“…[2][3][4][5][6][7] Preoperative psychophysiological state has been reported to affect surgical outcomes of spine surgery. [8][9][10] Hospital Anxiety and Depression Scale (HADS) is a self-administered scoring system for assessing anxiety and depression developed by Zigmond and Snaith, 11 which allows surgeons to evaluate each patient's anxiety and depressive state conveniently. Because this questionnaire has a merit in that somatic items relating to such emotional or physical disorders as insomnia or anorexia can be excluded, 12 it has often been used in the psychometric assessment of patients with spinal disorders.…”

Section: Introductionmentioning

confidence: 99%

Does Surgical Treatment Affect the Degree of Anxiety or Depression in Patients With Degenerative Cervical Myelopathy?

Tachibana

Doi

Nakajima

et al. 2022

Global Spine Journal

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Study Design Retrospective cohort study Objectives Preoperative mental state has been reported as one of the factors affecting the surgical outcomes of spine surgery, but few studies have examined in detail how patients’ mental state is affected by spine surgery. The purpose of this study was to investigate using the Hospital Anxiety and Depression Scale (HADS) whether surgery improves preoperative depression and anxiety in patients with degenerative cervical myelopathy. Methods We investigated patient-reported outcomes (Mental Component Summary, Physical Component Summary of SF-12 Health Survey, and EQ-5D, Neck Disability Index, JOACMEQ, satisfaction with treatment) and HADS one year after surgery, comparing them before and after surgery between April 2017 and February 2020. Among the cases diagnosed as preoperative anxiety and depression, we additionally compared the patient-reported outcomes based on the presence or absence of postoperative improvement in mental state, having also investigated the correlation between patient-reported outcomes and HADS for sub-analysis. Results Among the 99 patients eligible for inclusion in the present study, we found that patient-reported outcomes and the HADS scores improved significantly after surgery. There was a moderate correlation between the amount of change in HADS-D score before and after surgery and the amount of change in NDI (moderate, r = .41), NRS of neck (moderate, r = .46), and JOACMEQ (cervical spine function; moderate, r = .43, upper extremity function; moderate, r = .41, QOL; moderate, r = .41). Conclusions We found that surgical treatment for patients with degenerative cervical myelopathy may improve postoperative anxiety and depression as well as other patient-reported outcomes.

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“…Depression was associated with high decisional regret, despite treatment effectiveness. Multiple studies have examined the role of preoperative depression on surgical outcomes after spinal surgery 37–42 . These studies primarily focus on the relationship between depression and patient satisfaction (or health related quality of life measures), and not treatment decisional regret, which may be a more important and sensitive psychosocial outcome.…”

Section: Discussionmentioning

confidence: 99%