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More Than a Nuisance: Addressing Post-op Depression as an Essential Part of Recovery & Participation

Monday, March 04, 2019
Geri Lynn Baumblatt Recently, a friend had a minor surgery. Once he was safely home, he was surprised that he burst into tears. This was transient, but that’s not always the case. 
Over the past year as I’ve talked with people about a variety of procedures, and one story repeated: even when people were looking forward to something like a joint replacement so they could be more active again, they were often confounded to find themselves depressed in the days, weeks, and even months after surgery. As one woman told me, “I was relieved to finally have a hysterectomy to stop my bleeding. I definitely didn’t want to have more kids. But afterward, I was seriously depressed, and even had suicidal thoughts. I couldn’t understand why. But I felt like I was going crazy.” 

We know it’s normal for people to feel anxious before surgery, but do we help them understand that some people experience depression afterward? 
People expect pain and other challenges during recovery, but for those who also experience depression, not knowing this can happen creates confusion, embarrassment, and isolation.
Depression has been documented after many procedures coronary artery bypass graft, joint replacement, bariatric surgery, colon surgery. While it may be more common after certain procedures, there’s a risk with any surgery. And getting comfortable with identifying and addressing it can only improve patient experiences, engagement and outcomes.
Many factors may contribute: the body has been through a trauma (even if a planned trauma), effects of anesthesia, a post-op let-down effect, opioids, poor sleep, and depression or anxiety before surgery.
Unfortunately, not knowing it occurs makes it less likely people will reach out for help when they experience it. And:
  • This makes it much harder for them to participate in their recovery and rehab.
  • It lowers their threshold for pain, and can create a pain-depression feedback loop.
  • It increases morbidity and mortality.[1, 2]
Get out ahead of and behind it:
  • Studies recommend screening everyone for depression before procedures. This could also be used as an opportunity to both broach the topic with people and normalize it. [3]
  • Educate patients and family caregivers about post-op depression so they can recognize it, report it, and put it in perspective.
  • Help people understand what happens during surgery and set realistic expectations about recovery. Knowing what to expect reduces anxiety and gives people a sense of control. And less anxiety before surgery may mean less afterward.
  • Screen for depression during follow-up visits and calls. 
People can only participate in their care when they have energy; unfortunately, depression robs them of this. And including it as part of patient and family education can help people identify it, destigmatize it, and address it.  

Catch up with Geri this Spring at:

1. Guerini F, Morghen S, Lucchi E, Bellelli G, Trabucchi M. Depressive symptoms and one year mortality among elderly patients discharged from a rehabilitation ward after orthopaedic surgery of the lower limbs. Behav Neurol. 2010;23:117–21. doi: 10.1155/2010/365341. [PMC free article][PubMed] 
2. Thombs BD, de Jonge P, Coyne JC, Whooley MA, Frasure-Smith N, Mitchell AJ, et al. Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA. 2008;300:2161–71. doi: 10.1001/jama.2008.667. 
3. Ghoneim, M. M., & O'Hara, M. W. (2016). Depression and postoperative complications: an overview. BMC surgery16, 5. doi:10.1186/s12893-016-0120-y 

Geri Lynn Baumblatt MA, For the last 20 years, Geri has worked to help people understand health conditions and procedures, orient them to their diagnoses, make more informed decisions about their care, and partner with their care teams.  She oversaw the creation of the Emmi program library, and she regularly speaks and serves on patient engagement, patient experience, health literacy, shared decision making, health design, family caregiving, and heath communication panels for organizations like AHRQ, the Brookings Institute, Stanford Medicine X, and the Center for Plain Language. She serves on the editorial board for the Journal of Patient Experience, is on the board of the Society for Participatory Medicine, and published a chapter in Transformative Healthcare Practice through Patient Engagement (IGI Global). She currently consults on patient engagement, family caregiving, and health communication. Follow her on Twitter @GeriLynn

Tags: patient engagement, communication, patient education, expectations, experience, patient
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