A perioperative intervention combining psychological and pharmacologic management significantly reduced depression and anxiety scores at 3 months compared with usual care (MD 2.20; 95% CI 0.16-4.24).
RCT (n=306)
Single-blind
1:1
Yes
Does a perioperative intervention combining psychological management and pharmacologic optimization reduce depression and anxiety symptoms in older adults undergoing surgery?
A perioperative intervention combining psychological and pharmacologic management significantly reduced anxiety and depression in older adults undergoing surgery.
Mean Difference: 2.2 (95% CI 0.16–4.24)
p-value: p=.03
Importance Depression and anxiety are common among older adults undergoing surgery and are associated with adverse postoperative outcomes. However, effective tailored perioperative mental health interventions are lacking. Objective To evaluate a perioperative intervention to optimize mental health. Design, Setting, and Participants A single-blind, hybrid, type 1, effectiveness-implementation randomized clinical trial was conducted (November 1, 2022, to March 31, 2025), with 3-month postoperative follow-up, at a US academic and community practice hospital network. Participants were 60 years or older; scheduled for cardiac, oncologic, or orthopedic surgery; and had clinically meaningful symptoms of depression and/or anxiety based on the Patient Health Questionnaire–Anxiety and Depressive Symptom (PHQ-ADS) scale. A total of 3159 patients were screened for eligibility, with 1518 ineligible, 1079 declining participation, and 236 excluded for other reasons. A total of 326 patients were enrolled and randomized (1:1), with 20 excluded after surgery cancelation. Intervention Participants were assigned to receive a perioperative intervention combining psychological management and pharmacologic optimization or enhanced usual care (materials for self-managing symptoms). Main Outcomes and Measures The primary outcome was change in PHQ-ADS score from baseline to 3 months after surgery. Other outcomes included persistent postsurgical pain, delirium, falls, quality of life, patient satisfaction, length of stay, and rehospitalizations. Implementability was evaluated through semistructured interviews and reach, acceptability, feasibility, appropriateness, and fidelity measures. Results A total of 306 older adults were included in analysis (mean SD age, 68.5 6.1 years; 209 68.3% female; 153 randomized to intervention and 153 randomized to enhanced usual care): 102 cardiac, 100 oncologic, and 104 orthopedic patients. Participants’ mean (SD) baseline PHQ-ADS score was 18.5 (7.4). At 3 months, there was a significant decrease in PHQ-ADS scores in the intervention group compared with the enhanced usual care group (mean difference, 2.20; 95% CI, 0.16-4.24; P = .03). Effects varied by surgical subgroups (oncologic patients: mean difference, 4.93; 95% CI, 1.51-8.36; P = .005; cardiac patients: mean difference, 2.68; 95% CI, −0.98 to 6.35; P = .15; and orthopedic patients: mean difference, −1.11; 95% CI, −4.62 to 2.40; P = .54). Patients and interventionists perceived the intervention as appropriate, with high-fidelity delivery and broad reach across the target population. Conclusions and Relevance In this randomized clinical trial, psychological management and pharmacologic optimization reduced anxiety and depression in older adults undergoing surgery. Future studies should assess reproducibility and determine which patients benefit most. Trial Registration ClinicalTrials.gov Identifiers: NCT05575128 , NCT05685511 , and NCT05697835
“We recognize the importance of getting the body into shape before surgery, but preparing the mind and the brain is just as important. Patients undergoing major surgery hope for a better life afterward, and our study shows that we can help them by addressing their mental health.”
Abraham et al. (2026) conducted an RCT in Depression and anxiety in older adults undergoing surgery (n=306). Perioperative intervention combining psychological management and pharmacologic optimization vs. Enhanced usual care (materials for self-managing symptoms) was evaluated on Change in PHQ-ADS score from baseline to 3 months after surgery (MD 2.20, 95% CI 0.16-4.24, p=.03). A perioperative intervention combining psychological and pharmacologic management significantly reduced depression and anxiety scores at 3 months compared with usual care (MD 2.20; 95% CI 0.16-4.24).