title: Preoperative and perioperative predictors of reactive and persistent depression after cardiac surgery: a three-month follow-up study.
abstract: BACKGROUND
  Depression is commonly reported in patients after cardiac surgery and increases the risk of postoperative cardiac morbidity or mortality or both. Although preoperative depression has been implicated as the strongest predictor of depression after surgery, the characteristics thought to influence reactive or persistent depression have been poorly investigated in cardiac surgery patients.
  
  
  OBJECTIVE
  Therefore, the main aim of this study was to examine whether pre-existing depression rather than perioperative variables may predict postoperative reactive or persistent depression.
  
  
  METHODS
  Overall, 96 patients completed a psychologic evaluation, including the Center for Epidemiologic Studies of Depression scale and the State and Trait Anxiety Inventory for depression and anxiety, respectively, before surgery and at 3-month follow-up.
  
  
  RESULTS
  A total of 27 (28%) and 24 (25%) patients had depression preoperatively and at 3-month follow-up, respectively. Postoperative depression was predicted by preoperative scores in Center for Epidemiologic Studies of Depression scale (β = 0.29, p < 0.05) and European System for Cardiac Operative Risk Evaluation (β = 0.22, p < 0.04), but not by procedure-related variables (p > 0.75). Specifically, patients with reactive depression showed greater European System for Cardiac Operative Risk Evaluation than those without depression (p < 0.05), whereas patients with persistent depression had greater preoperative Center for Epidemiologic Studies of Depression scores than those whose depression improved after surgery (p < 0.01).
  
  
  CONCLUSIONS
  The severity of pre-existing depression and biomedical risk factors can be markers of depression-related risk 3 months after cardiac surgery in patients with persistent and reactive depression, respectively. An integrated psychologic and biomedical evaluation is essential to anticipate which patients are likely to show depression after cardiac surgery.
authors.affiliation: Department of General Psychology, University of Padova, Italy. Electronic address: elisabetta.patron@studenti.unipd.it.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Patron
authors.affiliation: Department of General Psychology, University of Padova, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Messerotti Benvenuti
authors.affiliation: Department of General Psychology, University of Padova, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Palomba
mesh_terms: D000275:Adjustment Disorders / Q000453:epidemiology*; D000368:Aged; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D001026:Coronary Artery Bypass; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D011446:Prospective Studies; D012307:Risk Factors