Psychiatric Disturbance and Acute Stress Responses in Surgical Patients

BACKGROUND: A number of reports have appeared of post-traumatic stress symptoms occurring in physically ill patients. This study sought to measure the extent of psychiatric disturbance and acute post-traumatic stress reactions occurring in surgical inpatients, and to examine their relationship with the stress of illness and hospitalization and the personal coping style of the patient. METHODS: Thirty-seven admissions to a general surgical unit were assessed on admission and immediately prior to discharge. Measures were made of depression, anxiety, cognitive impairment, post-traumatic stress symptoms, severity of illness, level of physical functioning, degree of hospital stress and coping style. RESULTS: There was a significant reduction in anxiety scores postoperatively. Twenty-seven per cent of patients developed high levels of acute post-traumatic stress symptoms and these correlated with depression at admission and intra-hospital stress. Depression at discharge was related to depression at admission, physical functioning and coping style. In general, avoidance and acceptance-resignation were associated with a poorer psychiatric outcome. CONCLUSIONS: Postoperative psychiatric disturbance, including acute stress symptoms, can be understood as a reaction to the 'trauma' of illness and hospitalization, predisposed to by pre-existing depression. Interventions could be directed at screening for at-risk patients, minimizing stress, and encouraging adaptive mechanisms of coping in patients.