Depressive Symptoms After CABG Surgery

Abstract

Objective Depression is highly comorbid with coronary artery disease. Clinicians face the question of whether patients’ depressive symptoms will improve after coronary artery bypass graft surgery (CABG). The objective of this meta-analysis is to determine the course of depressive symptoms after CABG. Methods EMBASE, PubMed, and PsycINFO were searched for studies assessing depression before and after CABG. Meta-analyses were performed for depression at early (1–2 weeks), recovery (>2 weeks to 2 months), mid (>2 months to 6 months), and late (>6 months) postoperative time points. Heterogeneity and publication bias were analyzed. Results Thirty-nine studies were included in the meta-analysis. Twelve reported dichotomous outcomes; 18 reported continuous outcomes; and 9 reported both. Risk of depression was increased early (relative risk [RR] = 1.27; 95% confidence interval [CI], 1.01–1.61). There was a significantly decreased risk of depression at recovery (RR = 0.78; 95% CI, 0.67–0.90), mid (RR = 0.64; 95% CI, 0.58–0.70), and late (RR = 0.68; 95% CI, 0.58–0.79) time points without heterogeneity. All studies reporting continuous depression scales had significant heterogeneity. Conclusions The risk of depression decreased post-CABG when depression was measured dichotomously. While depression improves overall and remits for some patients after CABG, the majority of patients will not experience remission of depression. Preoperative and postoperative depression monitoring is important.

Depression and anxiety after total joint replacement among older adults: a meta-analysis

“…However, the lack of control data limits our ability to draw any firm conclusions about the comparability of these rates to those of healthy older adults. The rates of clinically significant levels of depression in TJR patients are comparable to those seen in cardiac surgery patients (Ravven, Bader, Azar, & Rudolph, 2013), but are lower than those of thoracic surgery (Kitagawa et al, 2011;Okamoto, Motomura, Murashima, & Takamoto, 2013) and hip fracture patients (Guerini et al, 2010;Phillips, Upton, Duggal, Carroll, & Lord, 2013). The six studies that examined the prevalence of clinically significant levels of anxiety symptoms reported rates that ranged between 9% and 95%.…”

Do depression and anxiety profiles over time predict persistent post‐surgical pain? A study in cardiac surgery patients

“…Cardiac surgeries offer an ideal model to study the association between psychological distress and PPSP. In addition, up to 1/3 of patients undergoing cardiac surgeries experience elevated levels of preand post-surgical depressive and anxiety symptoms (Murphy et al, 2008a;McKenzie et al, 2010;Ravven et al, 2013) and this is associated with worse pain scores in the year following CABG (Karlsson et al, 1999;Choiniere et al, 2014). In addition, up to 1/3 of patients undergoing cardiac surgeries experience elevated levels of preand post-surgical depressive and anxiety symptoms (Murphy et al, 2008a;McKenzie et al, 2010;Ravven et al, 2013) and this is associated with worse pain scores in the year following CABG (Karlsson et al, 1999;Choiniere et al, 2014).…”

Cardiac surgery as a stressor and the response of the vulnerable older adult

“…A systematic review found that as patients entered the recovery period (2 weeks postoperatively), depressive symptoms measured on standard instruments and depression diagnosis was lower than preoperative levels. 78 Importantly, those who were diagnosed with depression more than 1 week prior to cardiac surgery were less likely to experience depression remission postoperatively. 78 This response to the mental health stress of cardiac surgery can provide valuable insight into cardiac surgery outcomes.…”

“…78 Importantly, those who were diagnosed with depression more than 1 week prior to cardiac surgery were less likely to experience depression remission postoperatively. 78 This response to the mental health stress of cardiac surgery can provide valuable insight into cardiac surgery outcomes.…”