title: Depression and anxiety in patients undergoing herniated disc surgery: relevant but underresearched - a systematic review.
abstract: BACKGROUND
  An association between depression and anxiety and musculoskeletal disorders has been consistently reported in the past years. This article provides a systematic overview of the literature on the prevalence rates of depression and anxiety in patients undergoing surgery for a herniated disc.
  
  
  METHODS
  A systematic literature search was conducted in the following electronic databases: PubMed, PsycINFO, Web of Science, Cochrane Library and PSYNDEXplus. The identified articles were evaluated for prevalence rates of depression and anxiety, methodological issues, change of depression and anxiety over time, and major findings on the impact of depression and anxiety on patients undergoing disc surgery.
  
  
  RESULTS
  Fourteen studies were identified. Prevalence rates for depression and anxiety in patients undergoing disc surgery varied between 21.5% and 49.3% before and between 4.1% and 79.6% after disc surgery. The study designs, the use of assessment instruments and cut-off values varied greatly. Depression and anxiety decreased within the population of disc surgery patients over time. Depression and anxiety were found to have a great impact on the postoperative outcome of surgery, return to work, analgesia abuse, pain experience, and abnormal illness behaviour.
  
  
  CONCLUSIONS
  Little research has been done to investigate depression and anxiety in patients undergoing surgery for a herniated disc. Evidently disc surgery patients are at higher risk of suffering from depression and anxiety than the general population. The review outlines the importance for clinicians to be more sensitive to psychological concerns in patients undergoing disc surgery. Psychological assessment and assistance from mental health professionals should be considered during the hospital stay and rehabilitation period, depending on local feasibility. Further investigations are necessary to examine whether the implementation of a multidisciplinary in-patient treatment program will improve postoperative outcome in patients undergoing intervertebral disc surgery.
authors.affiliation: Department of Psychiatry, Public Health Research Unit, University of Leipzig, Leipzig, Germany. Margrit.Zieger@medizin.uni-leipzig.de
authors.forename: M
authors.initials: M
authors.lastname: Zieger
authors.forename: R
authors.initials: R
authors.lastname: Schwarz
authors.forename: H-H
authors.initials: HH
authors.lastname: König
authors.forename: M
authors.initials: M
authors.lastname: Härter
authors.forename: S G
authors.initials: SG
authors.lastname: Riedel-Heller
mesh_terms: D001007:Anxiety / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D016208:Databases, Factual; D003863:Depression / Q000453:epidemiology / Q000209:etiology / Q000523:psychology*; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000523:psychology* / Q000601:surgery*; D019637:Orthopedic Procedures / Q000523:psychology*; D019990:Perioperative Care / Q000523:psychology*; D011183:Postoperative Complications / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics