Robert B Schonberger1, Jessica Feinleib2, Natalie Holt2, Feng Dai3, Cynthia Brandt2, Matthew M Burg4. 1. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT. Electronic address: robert.schonberger@yale.edu. 2. Department of Anesthesiology, Yale University School of Medicine, New Haven, CT; Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, CT. 3. Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, CT. 4. Department of Internal Medicine, University College of Physicians and Surgeons, West Haven, CT.
Abstract
OBJECTIVES: To test the association among depression symptoms, distressed personality type, and preoperative beta-blocker nonadherence and to estimate the prevalence of untreated major depression in this population. DESIGN: Prospective observational study. SETTING: A veterans hospital. PARTICIPANTS: One hundred twenty patients on outpatient beta-blocker therapy presenting for surgery. INTERVENTIONS: The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires. MEASUREMENTS AND MAIN RESULTS: Of 99 participants who presented for surgery, the incidence of preoperative nonadherence was 14.1% (95% confidence interval 7%-21%), consistent with prior research. Nonadherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate-to-severe depression (Cochran-Armitage test for trend p = 0.03). Distressed personality type was found in 35% of the cohort (95% confidence interval 26-45%) and was not associated with beta-blocker nonadherence (Fisher's exact test, p = 0.24). Among participants with symptoms of major depressive disorder (n = 25, 25.3%), more than half (n = 14, 56%) had no indication of depression listed at their most recent primary care visit. CONCLUSIONS: Patients with symptoms of depression on chronic beta-blocker therapy are susceptible to medication nonadherence on the day of surgery. Most surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus (1) identify a population at increased risk of beta-blocker withdrawal, and (2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition.
OBJECTIVES: To test the association among depression symptoms, distressed personality type, and preoperative beta-blocker nonadherence and to estimate the prevalence of untreated major depression in this population. DESIGN: Prospective observational study. SETTING: A veterans hospital. PARTICIPANTS: One hundred twenty patients on outpatient beta-blocker therapy presenting for surgery. INTERVENTIONS: The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires. MEASUREMENTS AND MAIN RESULTS: Of 99 participants who presented for surgery, the incidence of preoperative nonadherence was 14.1% (95% confidence interval 7%-21%), consistent with prior research. Nonadherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate-to-severe depression (Cochran-Armitage test for trend p = 0.03). Distressed personality type was found in 35% of the cohort (95% confidence interval 26-45%) and was not associated with beta-blocker nonadherence (Fisher's exact test, p = 0.24). Among participants with symptoms of major depressive disorder (n = 25, 25.3%), more than half (n = 14, 56%) had no indication of depression listed at their most recent primary care visit. CONCLUSIONS:Patients with symptoms of depression on chronic beta-blocker therapy are susceptible to medication nonadherence on the day of surgery. Most surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus (1) identify a population at increased risk of beta-blocker withdrawal, and (2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition.
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