The course of depression and anxiety in patients undergoing disc surgery

Objectives: Disc-related diseases represent a large contributor to the incidences of back pain in the general population (van Dieën et al., 1999). This study examines longitudinal depression and anxiety rates in disc surgery patients in comparison to the general population, the change and associated determinants of depression and anxiety over time. Methods: The longitudinal observational study refers to 305 consecutive disc surgery patients (age range: 18–55 years). Depression and anxiety was assessed with the Hospital Anxiety and Depression Scale. Random effects regression models for unbalanced panel data were used. Results: Depression and anxiety decreases significantly during nine months after surgery. Depression rates vary between 23.6% (T0), 9.6% (T1) and 13.1% (T2). Only at T0 the depression rate differs significantly from the general population. Anxiety rates range between 23.7% (T0), 10.9% (T1) and 11.1% (T2). Compared to the general population anxiety rates are significantly higher at all three assessment points. Risk factors for anxiety or depression at the time of the surgery are psychiatric comorbidity before surgery, higher age, female gender, lower educational level, lower physical health status and higher pain intensity. Regarding depression and anxiety in the course of time significant time interactions were found for the existence of other chronic diseases, higher pain intensity and vocational dissatisfaction. Conclusions: Compared to the general population patients undergoing herniated disc surgery are often affected by depression and anxiety during hospital treatment and also in the course of time. Multimodal diagnostics regarding psychological well-being, pain and physical health status may help to identify this risk group. The assistance by mental health professionals during hospital and rehabilitation treatment may reduce poor postoperative outcome.

Literatur: van Dieën, J. H., Weinans, H., and Toussaint, H. M. Fractures of the Lumbar Vertebral Endplate in the Etiology of Low Back Pain: a Hypothesis on the Causative Role of Spinal Compression in Aspecific Low Back Pain. Med Hypotheses 1999;53(3):246-52.

anxiety - depression - disc surgery - psychiatric comorbidity