Colostomy patients: psychological adjustment at 10 weeks and 1 year after surgery in districts which employed stoma-care nurses and districts which did not.

Two hundred and fifteen colostomy patients were interviewed at 10 weeks after surgery from a stratified random sample of 12 health districts in which stoma-care nurses were employed and eight other districts: 85 survivors who did not have restorative surgery were reinterviewed 1 year later. The Present State Examination (PSE) was used to assess the prevalence of affective disorder on both occasions. Analysis of covariance of the 10-week PSE scores revealed that age was unrelated to psychological adjustment after controlling for the extent and severity of patients' symptoms and that patients in districts which employed stoma-care nurses had significantly lower PSE scores. Single and widowed males appeared to enjoy better emotional health than married men and than women. Analysis of covariance of PSE scores obtained 1 year later also revealed that age was unrelated to psychological adjustment after controlling for the patients' physical state. No difference was found between patients who had access to a National Health Service stoma-care nurse and patients in other districts, many of whom had seen a representative from one of the appliance companies. The finding that single and widowed males appeared to fare better than married men was repeated. Ten per cent of patients who felt completely well were anxious or depressed. Psychiatric referral may be inappropriate for the majority of depressed patients who may instead benefit from medical treatment or from nursing intervention to deal with physical symptoms such as pain or urinary incontinence.