Abstract
Objectives
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.
Results
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.
Conclusions
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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to European Journal of Obstetrics and Gynecology and Reproductive BiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Psychological outcomes after hysterectomy for benign conditions: a systematic review and meta-analysis.Eur J Obstet Gynecol Reprod Biol. 2014; 174: 5-19
- The psychological outcome of hysterectomy.Gynecol Endocrinol. 2000; 14: 132-141
- Prophylactic oophorectomy at elective hysterectomy: effects on psychological well-being at 1-year follow-up and its correlations to sexuality.Maturitas. 2005; 51: 349-357
- Hysterectomy Multicentre Study Group in South-East S. A 1-year follow up of psychological wellbeing after subtotal and total hysterectomy–a randomised study.BJOG. 2010; 117: 479-487
- Risk factors for major depressive disorder and the psychological impact of hysterectomy: a prospective investigation.Psychosomatics. 2008; 49: 137-142
- Psychosocial effects of hysterectomy: literature review.J Psychosom Res. 2005; 59: 117-129
- Depressive symptoms before and after elective hysterectomy.J Obstet Gynecol Neonatal Nurs. 2011; 40: 566-576
- A prospective study of changes in negative mood states of women undergoing surgical hysterectomy: the relationship to cognitive predisposition and familial support.J Psychosom Obstet Gynaecol. 1997; 18: 22-30
- Bilateral oophorectomy and depressive symptoms 12 months after hysterectomy.Am J Obstet Gynecol. 2008; 199 (22 e1-e5)
- The role of child abuse and age in vulnerability to emotional problems after surgery for breast cancer.Eur J Cancer. 2006; 42: 2517-2523
- Women's subjective experience of hysterectomy.Aust Health Rev. 1996; 19: 40-55
- Recovery 3 and 12 months after hysterectomy: epidemiology and predictors of chronic pain, physical functioning, and global surgical recovery.Medicine (Baltimore). 2016; 95: e3980
- Rapport van de Werkgroep Revisie POLS-Gezondheidsenquête 1999.Statistics Netherlands (CBS), Heerlen2003
- The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection.Med Care. 1992; 30: 473-483
- Pain assessment: global use of the Brief Pain Inventory.Ann Acad Med Singapore. 1994; 23: 129-138
- Validation of the Dutch version of the DN4 diagnostic questionnaire for neuropathic pain.Pain Pract. 2013; 13: 390-398
- Validation of the surgical fear questionnaire in adult patients waiting for elective surgery.PLoS One. 2014; 9: e100225
- The pain catastrophizing scale: development and validation.Psychol Assess. 1995; 7: 524-532
- Distinguishing optimism from neuroticism (and trait anxiety, self-mastery, and self-esteem): A reevaluation of the Life Orientation Test.J Pers Soc Psychol. 1994; 67: 1063-1078
- A short form of the Positive and Negative Affect Schedule: evaluation of factorial validity and invariance across demographic variables in a community sample.Pers Indiv Differ. 1999; 27: 405-416
- The MOS social support survey.Soc Sci Med. 1991; 32: 705-714
- A brief two-item screener for detecting a history of physical or sexual abuse in childhood.Gen Hosp Psychiatry. 2007; 29: 8-13
- The CES-D scale: a self-report depression scale for research in the general population.Appl Psych Meas. 1977; 1: 385-401
- The 12-Item well-being questionnaire: origins, current stage of development, and availability.Diabetes Care. 2000; 23: 875
- Depression, anxiety, hostility and hysterectomy.J Psychosom Obstet Gynaecol. 2005; 26: 193-204
- Depression and postoperative complications: an overview.BMC Surg. 2016; 16: 5
- Depression is an inflammatory disease, but cell-mediated immune activation is the key component of depression.Prog Neuropsychopharmacol Biol Psychiatry. 2011; 35: 664-675
- Understanding pre- and post-hysterectomy levels of negative affect: a stress moderation model approach.J Psychosom Obstet Gynaecol. 2003; 24: 99-109
- Negative and positive affect are independently associated with patient-reported health status following percutaneous coronary intervention.Qual Life Res. 2009; 18: 953-960
- Associations between social support and stroke survivors' health-related quality of life–a systematic review.Patient Educ Couns. 2013; 93: 169-176
- Optimism.Clin Psychol Rev. 2010; 30: 879-889
- A prospective study of 3 years of outcomes after hysterectomy with and without oophorectomy.Am J Obstet Gynecol. 2006; 194: 711-717
- Psychological wellbeing after laparoscopic and abdominal hysterectomy–a randomised controlled multicentre study.BJOG. 2006; 113: 1023-1030
- The influence of psychological factors on recovery from hysterectomy.J R Soc Med. 2010; 103: 56-59
Article info
Publication history
Published online: August 17, 2017
Accepted:
August 12,
2017
Received in revised form:
August 10,
2017
Received:
December 23,
2016
Footnotes
☆This study was conducted in Maastricht, Sittard-Geleen, Eindhoven, and Veldhoven, The Netherlands.
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
