Psychiatric disturbance and acute stress responses in surgical patients.
BACKGROUND
A number of reports have appeared of post-traumatic stress symptoms occurring in physically ill patients. This study sought to measure the extent of psychiatric disturbance and acute post-traumatic stress reactions occurring in surgical inpatients, and to examine their relationship with the stress of illness and hospitalization and the personal coping style of the patient.


METHODS
Thirty-seven admissions to a general surgical unit were assessed on admission and immediately prior to discharge. Measures were made of depression, anxiety, cognitive impairment, post-traumatic stress symptoms, severity of illness, level of physical functioning, degree of hospital stress and coping style.


RESULTS
There was a significant reduction in anxiety scores postoperatively. Twenty-seven per cent of patients developed high levels of acute post-traumatic stress symptoms and these correlated with depression at admission and intra-hospital stress. Depression at discharge was related to depression at admission, physical functioning and coping style. In general, avoidance and acceptance-resignation were associated with a poorer psychiatric outcome.


CONCLUSIONS
Postoperative psychiatric disturbance, including acute stress symptoms, can be understood as a reaction to the 'trauma' of illness and hospitalization, predisposed to by pre-existing depression. Interventions could be directed at screening for at-risk patients, minimizing stress, and encouraging adaptive mechanisms of coping in patients.
Clarke
D M
DM
Consultation-Liaison Psychiatry Research Unit, Monash University Department of Psychological Medicine, Melbourne, Victoria, Australia.
Russell
P A
PA
Polglase
A L
AL
McKenzie
D P
DP
D000208:Acute Disease; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology*; D003863:Depression / Q000453:epidemiology*; D006801:Humans; D008875:Middle Aged; D010343:Patient Admission; D010351:Patient Discharge; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D013315:Stress, Psychological; D013514:Surgical Procedures, Operative / Q000523:psychology*