title: Parathyroidectomy, elevated depression scores, and suicidal ideation in patients with primary hyperparathyroidism: results of a prospective multicenter study.
abstract: OBJECTIVE
  To assess anxiety and depression symptoms, suicidal ideation, and health-related quality of life (HRQOL) in a large series of consecutive patients with primary hyperparathyroidism (pHPT) before and after parathyroidectomy.
  
  
  METHODS
  This prospective multicenter study investigated preoperative and postoperative depression, anxiety, suicidal ideation, and HRQOL in patients with pHPT and compared these variables with a control group with nontoxic thyroid nodules.
  
  
  METHODS
  The study included 194 patients with pHPT and 186 control subjects.
  
  
  METHODS
  Depression was evaluated with the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9, which also assessed suicidal ideation. Anxiety was evaluated with the HADS. Health-related quality of life was measured with the 36-Item Short Form survey.
  
  
  RESULTS
  Parathyroidectomy achieved a 98% cure rate. Preoperatively, severe depression (HADS score ≥ 11) was seen in 20% of the pHPT group and 9% of the control group. The Patient Health Questionnaire-9 detected moderate to severe depression in 17% of the patients with pHPT and 7% of the control subjects. Patients with pHPT had higher HADS anxiety scores (mean, 7.7) than control subjects (P < .01) or the German normative sample (P < .001). Compared with control subjects, patients with pHPT had significantly lower 36-Item Short Form survey preoperative physical and mental health summary scores (42.7 vs 49.5 and 41.2 vs 46.8, respectively; P = .001 for both comparisons). At 12 months follow-up, depression and anxiety decreased significantly in patients with pHPT; the prevalence of suicidal ideation was more than halved from the baseline (10.7% vs 22%; P = .008). Both physical and mental health scores (45.7 and 47.7, respectively) improved in patients with pHPT (P < .001 each) but not in control subjects.
  
  
  CONCLUSIONS
  Depression, anxiety, and decreased HRQOL appear to be related to pHPT. Successful parathyroidectomy seems to reduce psychopathologic symptoms and improve HRQOL in this setting.
authors.affiliation: Department of Surgery, University Hospital, Ulm, Germany. theresia.weber@uniklinik-ulm.de
authors.forename: Theresia
authors.initials: T
authors.lastname: Weber
authors.forename: Julia
authors.initials: J
authors.lastname: Eberle
authors.forename: Ursula
authors.initials: U
authors.lastname: Messelhäuser
authors.forename: Leif
authors.initials: L
authors.lastname: Schiffmann
authors.forename: Christoph
authors.initials: C
authors.lastname: Nies
authors.forename: Jochen
authors.initials: J
authors.lastname: Schabram
authors.forename: Andreas
authors.initials: A
authors.lastname: Zielke
authors.forename: Katharina
authors.initials: K
authors.lastname: Holzer
authors.forename: Edit
authors.initials: E
authors.lastname: Rottler
authors.forename: Doris
authors.initials: D
authors.lastname: Henne-Bruns
authors.forename: Monika
authors.initials: M
authors.lastname: Keller
authors.forename: Jörn
authors.initials: J
authors.lastname: von Wietersheim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications / Q000523:psychology / Q000601:surgery*; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000523:psychology*; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011788:Quality of Life; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D055815:Young Adult