Prevalence and predictors of depression and well-being after hysterectomy: An observational study

  • Maurice Theunissen
    Corresponding author at: Department of Anaesthesiology and Pain Management, Maastricht UMC+, PO Box: 5800, 6202 AZ Maastricht, The Netherlands.
    Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, The Netherlands
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  • Madelon L. Peters
    Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
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  • Jan Schepers
    Department of Methodology and Statistics, Maastricht University, The Netherlands
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  • Dick C. Schoot
    Department of Gynaecology, Catharina Hospital, Eindhoven, The Netherland

    Department of Gynaecology, Ghent University Hospital, Ghent, Belgium
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  • Hans-Fritz Gramke
    Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, The Netherlands
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  • Author Footnotes
    1 Present address: Department of Anaesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar.
    Marco A. Marcus
    1 Present address: Department of Anaesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar.
    Department of Anaesthesiology and Pain Management, Maastricht University Medical Centre+, Maastricht, The Netherlands
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  • Author Footnotes
    1 Present address: Department of Anaesthesia/ICU and Perioperative Medicine, Hamad Medical Corporation, Doha, Qatar.



      To assess risk and predictive factors for depression and well-being, 3 and 12 months after elective hysterectomy. Secondary objectives were to assess the incidence of depression, level of well-being, and feelings of femininity.

      Study design

      A prospective multicenter cohort study was performed among 419 women, undergoing hysterectomy for benign indication. Data were collected in the week prior to surgery, and in the per- and postoperative period up to the fourth postoperative day and 3 and 12 months after surgery. Sociodemographic variables, baseline health status, psychosocial predictors, and surgery data were assessed. Outcome measures were Center for Epidemiological Studies-Depression scale (CES-D, range 0–60), the 12-item well-being questionnaire energy and positive well-being subscales (range 0–12), and feelings of femininity. Predictor analyses were performed using linear mixed model analyses.


      Levels of depression, energy, and positive well-being after hysterectomy were predicted by their corresponding baseline levels (estimate 0.62 p< 0.001, 0.39 p< 0.001, 0.37 p< 0.001, respectively) and baseline pain (0.31 p = 0.003, −0.09 p = 0.026, −0.10 p = 0.008). Postoperative infection reported at 12 months affected CES-D and energy level. Several other gynaecological, psychosocial, or perioperative factors were also predictive for one of the outcomes. Prevalence of depression at baseline, 3 and 12 months was 24%, 19%, and 21%, respectively. In general, well-being scores were slightly higher 3 and 12 months after hysterectomy than at baseline. Feelings of femininity were not negatively affected in 92% of the patients.


      Preoperative psychosocial status, perioperative pain, and postoperative infection were found as predictors of psychological outcome after hysterectomy. In the majority of patients we observed small but significant improvements with regard to postoperative depression and well-being, while feelings of femininity were unaffected.


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