Post-traumatic stress and psychological adjustment following major surgery: a systematic review of pain, social support, and coping factors

Major surgical procedures can produce psychological consequences that persist beyond physical healing, yet the determinants of post-surgical emotional outcomes are not fully understood. To review post-traumatic stress symptoms and psychological adjustment in general following major surgery, 25 primary studies were synthesized, focusing on postoperative pain, social support and coping. The review examined the relationship between physical distress, interpersonal resources and behavioral responses with recovery from a biopsychosocial and transactional stress-appraisal lens. Systematic searching was used to identify studies involving surgical adults, studies were then screened with pre-established criteria, and studies were critically appraised using appropriate design type methods. The methodological quality was mixed: confounding was a recurring issue; self-reported measures were a problem; and incomplete follow-up was an issue. In general, greater levels of acute/persistent pain, perceived threat, maladaptive coping, and limited interpersonal support were associated with poorer psychological outcomes, while higher levels of perceived support, adaptive coping, resilience, and perceived control were associated with better psychological adjustment. There was considerable heterogeneity in surgical populations, measures, follow-up time, and measures of effect, which precluded comparison and quantitative synthesis or meta-analysis. The results indicated that psychological risk assessment, pain control, support and relationship-oriented care, and coping strategies could be further assessed. This review highlights the importance of focusing on the physical, interpersonal and behavioural dimension together, and the importance of the close relationship and perceived support in psychological recovery after major surgery.