Preoperative and perioperative predictors of reactive and persistent depression after cardiac surgery: A three-month follow-up study

Objective: Depression is commonly reported in patients after cardiac surgery and increases the risk of postoperative cardiac morbidity and/or mortality. Although preoperative depression has been implicated as the strongest predictor of depression after surgery, the characteristics thought to influence reactive or persistent depression have been poorly investigated in cardiac surgery patients. Therefore, the main aim of this study was to examine whether preexisting depression rather than perioperative variables may predict postoperative reactive or persistent depression. Methods: Ninety-six patients completed a psychological evaluation, including the Center for Epidemiologic Studies of Depression (CES-D) scale and the State and Trait Anxiety Inventory (STAI Y1/Y2) for depression and anxiety, respectively, before surgery and at three-month follow-up. Results: Twenty-seven (28%) and 24 (25%) patients had depression preoperatively and at three-month follow-up, respectively. Postoperative depression was predicted by preoperative scores in CES-D (beta= 0.29, P < .05) and European System for Cardiac Operative Risk Evaluation (EuroSCORE) (beta = 0.22, P < .04), but not by procedure-related variables (Ps > .75). Specifically, patients with reactive depression showed greater EuroSCORE than those without depression (P < .05), whereas patients with persistent depression had greater preoperative CES-D scores than those whose depression improved after surgery (P < .01). Conclusions: The severity of preexisting depression and biomedical risk factors can be markers of depression-related risk three months after cardiac surgery in patients with persistent and reactive depression, respectively. An integrated psychological and biomedical evaluation is essential to anticipate which patients are likely to show depression after cardiac surgery.