title: Preoperative depression symptom severity and its impact on adherence to preoperative beta-blocker therapy.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A veterans hospital.
  
  
  METHODS
  One hundred twenty patients on outpatient beta-blocker therapy presenting for surgery.
  
  
  METHODS
  The Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires.
  
  
  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.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT. Electronic address: robert.schonberger@yale.edu.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Schonberger
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT; Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, CT.
authors.forename: Jessica
authors.initials: J
authors.lastname: Feinleib
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT; Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, CT.
authors.forename: Natalie
authors.initials: N
authors.lastname: Holt
authors.affiliation: Yale School of Public Health, Yale Center for Analytical Sciences, New Haven, CT.
authors.forename: Feng
authors.initials: F
authors.lastname: Dai
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, New Haven, CT; Department of Anesthesiology, VA Connecticut Healthcare System, West Haven, CT.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Brandt
authors.affiliation: Department of Internal Medicine, University College of Physicians and Surgeons, West Haven, CT.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Burg
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003865:Major Depressive Disorder / Q000453:epidemiology* / Q000523:psychology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011300:Preoperative Care / Q000379:methods* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012306:Risk; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists
keywords: beta-adrenergic blockers; depression; medication adherence; preoperative care; preventive medicine