Preoperative depression symptom severity and its impact on adherence to preoperative beta-blocker therapy

J Cardiothorac Vasc Anesth. 2014 Dec;28(6):1467-73. doi: 10.1053/j.jvca.2014.05.006. Epub 2014 Sep 26.

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.

Keywords: beta-adrenergic blockers; depression; medication adherence; preoperative care; preventive medicine.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adrenergic beta-Antagonists / administration & dosage*
  • Adult
  • Aged
  • Aged, 80 and over
  • Depressive Disorder, Major / epidemiology*
  • Depressive Disorder, Major / psychology*
  • Female
  • Humans
  • Incidence
  • Male
  • Medication Adherence / psychology*
  • Medication Adherence / statistics & numerical data*
  • Middle Aged
  • Preoperative Care / methods*
  • Preoperative Care / statistics & numerical data
  • Prospective Studies
  • Risk
  • Severity of Illness Index
  • Surveys and Questionnaires

Substances

  • Adrenergic beta-Antagonists