Screening and management of preoperative negative emotion in patients undergoing cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

CHEN Li ¹ , LI Tao ¹ , LI Qing ² ,  QIAN Yongjun ¹

1. Department of Cardiovascular Surgery, West China Hospital, National Clinical Research Center for Geriatrics, Sichuan University, Chengdu, 610041, P.R.China;
2. Mental Health Center, Center for Brain Science Research, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

QIAN Yongjun, Email: qianyongjun@scu.edu.cn

Keywords：

Preoperative; negative emotion; cardiac surgery; assessment

DOI：

10.7507/1007-4848.201907028

Video：

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Objective To investigate the negative emotions of patients before cardiac surgery in West China Hospital in order to analyze the related factors.Methods The Huaxi emotional-distress index (HEI), a screening tool for mood disorders developed by the Mental Health Center of West China Hospital, was used for preoperative psychological evaluation of 1 968 adult patients hospitalized in cardiac surgery from March 2016 to July 2014. There were 835 males and 1 133 females at age of 49±13 years.Results Fifty-one patients (2.6%) had negative emotions, among whom 6 patients were screened for suicide risk. After intervention, none of them had serious consequences caused by adverse emotions, such as automatic discharge from hospital, avoidance of surgery and suicide.Conclusion This study found that most of the cardiac surgery patients in West China Hospital have good psychological status before surgery, and a few suffered from negative emotions. “Huaxi emotional-distress index” is simple, effective and worth promoting.

Citation： CHEN Li, LI Tao, LI Qing, QIAN Yongjun. Screening and management of preoperative negative emotion in patients undergoing cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(12): 1223-1227. doi: 10.7507/1007-4848.201907028 Copy

1.	Humphreys JM, Denson LA, Baker RA, et al. The importance of depression and alcohol use in coronary artery bypass graft surgery patients: risk factors for delirium and poorer quality of life. J Geriatr Cardiol, 2016, 13(1): 51-57.
2.	Rothenhäusler HB, Grieser B, Nollert G, et al. Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study. Gen Hosp Psychiatry, 2005, 27(1): 18-28.
3.	Caumo W, Cardoso MB. Perioperative anxiety: Psychobiology and effects in postoperative recovery. Pain Clin, 2003, 15(2): 87-101.
4.	Navarro-García MA, Marín-Fernández B, de Carlos-Alegre V, et al. Preoperative mood disorders in patients undergoing cardiac surgery: risk factors and postoperative morbidity in the intensive care unit. Rev Esp Cardiol, 2011, 64(11): 1005-1010.
5.	Székely A, Balog P, Benkö E, et al. Anxiety predicts mortality and morbidity after coronary artery and valve surgery--a 4-year follow-up study. Psychosom Med, 2007, 69(7): 625-631.
6.	Hernández-Palazón J, Fuentes-García D, Falcón-Araña L, et al. Assessment of preoperative anxiety in cardiac surgery patients lacking a history of anxiety: Contributing factors and postoperative morbidity. J Cardiothorac Vasc Anesth, 2018, 32(1): 236-244.
7.	Prina AM, Cosco TD, Dening T, et al. The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: a systematic review. J Psychosom Res, 2015, 78: 25-33.
8.	Ramesh C, Nayak BS, Pai VB, et al. Pre-operative anxiety in patients undergoing coronary artery bypass graft surgery – A cross-sectional study. Inter J Afr Nurs Sci, 2017, 7: 31-36.
9.	Guo P, East L, Arthur A. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial. Intern J Nurs Stud, 2012, 49(2): 129-137.
10.	Bauer BA, Cutshall SM, Wentworth LJ, et al. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Compl Ther Clin Prac, 2010, 16(2): 70-75.
11.	余春华, 李俊英, 郑儒君, 等. 巴林特小组活动在促进肿瘤科护士心理健康中的效果探究. 华西医学, 2017, 32(5): 749-752.
12.	Wang J, Guo WJ, Zhang L, et al. The development and validation of Huaxi emotional-distress index(HEI): A Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings. Comprehensive Psychiatry, 2017, 76: 87-97.
13.	Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med, 2001, 16: 606-613.
14.	Spitzer RL, Kroenke K, Williams JW, et al. A brief measure for assessing generalized anxiety disorder: the gad-7. Arch Intern Med, 2006, 166(10): 1092-1097.
15.	Beck AT, Ward CH, Mendelson M, et a1. An inventory for measuring depression. Arch Gen Psychiatry, 1961, 4(6): 561-571.
16.	Snaith RP, Zigmond AS. The hospital anxiety and depression scale. BMJ, 1986, 292(6516): 344.
17.	Chang SM, Hahm BJ, Lee JY, et al. Cross-national difference in the prevalence of depression caused by the diagnostic threshold. J Affec Disord, 2008, 106(1-2): 159-167.
18.	Kołodziej T, Maciejewski T, Mendrala K, et al. Enhanced recovery after cardiac surgery. Polish J Thorac Cardiovasc Surg, 2019, 16(1): 32-36.
19.	Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol, 2011, 12(2): 160-174.
20.	Craven MA, Bland R. Depression in primary care: current and future challenges. Can J Psychiatry, 2013, 58(8): 442-448.
21.	Kroenke K, Spitzer RL, Williams JBW, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med, 2007, 146(5): 317-325.
22.	Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues Clin Neurosci, 2011, 13(1): 7-23.
23.	Sareen J, Jacobi F, Cox BJ, et al. Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Arch Intern Med, 2006, 166(19): 2109-2116.
24.	Cuijpers P, Vogelzangs N, Twisk J, et al. Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry, 2014, 171(4): 453-462.
25.	Koivula M, Paunonen-Ilmonen M, Tarkka MT, et al. Fear and anxiety in patient awaiting coronary artery bypass grafting. Heart Lung, 2001, 30(4): 302-311.
26.	Vingerhoets G. Perioperative anxiety and depression in open-heart surgery. Psychosomatics, 1998, 39(1): 30-37.
27.	中国康复学会心血管病专业委员会, 中同老年学学会心脑血管病专业委员会. 在心血管科就诊患者的心理处方中国专家共识. 中华心血管病杂志, 2014, 42(1): 6-13.
28.	Blumenlhal JA, Feger BJ, Smith PJ, et al. Treatment of anxiety in patients with coronary heart disease: Rationale and design of the Understanding the benefits of exercise and escitalopram in anxious patients with coronary heart disease (UNWIND) randomized clinical trial. Am Heart J, 2016, 176: 53-62.
29.	陈雪, 唐泓波, 胡大清. 739 例心脏瓣膜手术患者住院时间及费用分析. 医学综述, 2012, 18(11): 1772-1774.
30.	冯雪, 袁洁, 李四维, 等. 比较两种测量方法对心脏外科手术术前患者焦虑抑郁的评估结果. 中国循证心血管医学杂志, 2016, 8(11): 1386-1388.
31.	Placido A, Sposito AC. Association between suicide and cardiovascular disease: time series of 27 years. Intern J Cardiol, 2009, 135(2): 261-262.
32.	董丽平, 石元洪, 童萍, 等. 维持性血液透析患者自杀风险及相关心理社会影响因素调查. 中华社会医学杂志, 2015, 32(1): 52-54.
33.	何军. 成年癫痫患者的自杀风险及相关危险因素研究. 中国实用神经疾病杂志, 2014, 17(22): 8-10.

1. Humphreys JM, Denson LA, Baker RA, et al. The importance of depression and alcohol use in coronary artery bypass graft surgery patients: risk factors for delirium and poorer quality of life. J Geriatr Cardiol, 2016, 13(1): 51-57.
2. Rothenhäusler HB, Grieser B, Nollert G, et al. Psychiatric and psychosocial outcome of cardiac surgery with cardiopulmonary bypass: a prospective 12-month follow-up study. Gen Hosp Psychiatry, 2005, 27(1): 18-28.
3. Caumo W, Cardoso MB. Perioperative anxiety: Psychobiology and effects in postoperative recovery. Pain Clin, 2003, 15(2): 87-101.
4. Navarro-García MA, Marín-Fernández B, de Carlos-Alegre V, et al. Preoperative mood disorders in patients undergoing cardiac surgery: risk factors and postoperative morbidity in the intensive care unit. Rev Esp Cardiol, 2011, 64(11): 1005-1010.
5. Székely A, Balog P, Benkö E, et al. Anxiety predicts mortality and morbidity after coronary artery and valve surgery--a 4-year follow-up study. Psychosom Med, 2007, 69(7): 625-631.
6. Hernández-Palazón J, Fuentes-García D, Falcón-Araña L, et al. Assessment of preoperative anxiety in cardiac surgery patients lacking a history of anxiety: Contributing factors and postoperative morbidity. J Cardiothorac Vasc Anesth, 2018, 32(1): 236-244.
7. Prina AM, Cosco TD, Dening T, et al. The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: a systematic review. J Psychosom Res, 2015, 78: 25-33.
8. Ramesh C, Nayak BS, Pai VB, et al. Pre-operative anxiety in patients undergoing coronary artery bypass graft surgery – A cross-sectional study. Inter J Afr Nurs Sci, 2017, 7: 31-36.
9. Guo P, East L, Arthur A. A preoperative education intervention to reduce anxiety and improve recovery among Chinese cardiac patients: a randomized controlled trial. Intern J Nurs Stud, 2012, 49(2): 129-137.
10. Bauer BA, Cutshall SM, Wentworth LJ, et al. Effect of massage therapy on pain, anxiety, and tension after cardiac surgery: a randomized study. Compl Ther Clin Prac, 2010, 16(2): 70-75.
11. 余春华, 李俊英, 郑儒君, 等. 巴林特小组活动在促进肿瘤科护士心理健康中的效果探究. 华西医学, 2017, 32(5): 749-752.
12. Wang J, Guo WJ, Zhang L, et al. The development and validation of Huaxi emotional-distress index(HEI): A Chinese questionnaire for screening depression and anxiety in non-psychiatric clinical settings. Comprehensive Psychiatry, 2017, 76: 87-97.
13. Kroenke K, Spitzer RL, Williams JBW. The PHQ-9. J Gen Intern Med, 2001, 16: 606-613.
14. Spitzer RL, Kroenke K, Williams JW, et al. A brief measure for assessing generalized anxiety disorder: the gad-7. Arch Intern Med, 2006, 166(10): 1092-1097.
15. Beck AT, Ward CH, Mendelson M, et a1. An inventory for measuring depression. Arch Gen Psychiatry, 1961, 4(6): 561-571.
16. Snaith RP, Zigmond AS. The hospital anxiety and depression scale. BMJ, 1986, 292(6516): 344.
17. Chang SM, Hahm BJ, Lee JY, et al. Cross-national difference in the prevalence of depression caused by the diagnostic threshold. J Affec Disord, 2008, 106(1-2): 159-167.
18. Kołodziej T, Maciejewski T, Mendrala K, et al. Enhanced recovery after cardiac surgery. Polish J Thorac Cardiovasc Surg, 2019, 16(1): 32-36.
19. Mitchell AJ, Chan M, Bhatti H, et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol, 2011, 12(2): 160-174.
20. Craven MA, Bland R. Depression in primary care: current and future challenges. Can J Psychiatry, 2013, 58(8): 442-448.
21. Kroenke K, Spitzer RL, Williams JBW, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med, 2007, 146(5): 317-325.
22. Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues Clin Neurosci, 2011, 13(1): 7-23.
23. Sareen J, Jacobi F, Cox BJ, et al. Disability and poor quality of life associated with comorbid anxiety disorders and physical conditions. Arch Intern Med, 2006, 166(19): 2109-2116.
24. Cuijpers P, Vogelzangs N, Twisk J, et al. Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry, 2014, 171(4): 453-462.
25. Koivula M, Paunonen-Ilmonen M, Tarkka MT, et al. Fear and anxiety in patient awaiting coronary artery bypass grafting. Heart Lung, 2001, 30(4): 302-311.
26. Vingerhoets G. Perioperative anxiety and depression in open-heart surgery. Psychosomatics, 1998, 39(1): 30-37.
27. 中国康复学会心血管病专业委员会, 中同老年学学会心脑血管病专业委员会. 在心血管科就诊患者的心理处方中国专家共识. 中华心血管病杂志, 2014, 42(1): 6-13.
28. Blumenlhal JA, Feger BJ, Smith PJ, et al. Treatment of anxiety in patients with coronary heart disease: Rationale and design of the Understanding the benefits of exercise and escitalopram in anxious patients with coronary heart disease (UNWIND) randomized clinical trial. Am Heart J, 2016, 176: 53-62.
29. 陈雪, 唐泓波, 胡大清. 739 例心脏瓣膜手术患者住院时间及费用分析. 医学综述, 2012, 18(11): 1772-1774.
30. 冯雪, 袁洁, 李四维, 等. 比较两种测量方法对心脏外科手术术前患者焦虑抑郁的评估结果. 中国循证心血管医学杂志, 2016, 8(11): 1386-1388.
31. Placido A, Sposito AC. Association between suicide and cardiovascular disease: time series of 27 years. Intern J Cardiol, 2009, 135(2): 261-262.
32. 董丽平, 石元洪, 童萍, 等. 维持性血液透析患者自杀风险及相关心理社会影响因素调查. 中华社会医学杂志, 2015, 32(1): 52-54.
33. 何军. 成年癫痫患者的自杀风险及相关危险因素研究. 中国实用神经疾病杂志, 2014, 17(22): 8-10.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Screening and management of preoperative negative emotion in patients undergoing cardiac surgery

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