Elsevier

The Spine Journal

Volume 18, Issue 7, July 2018, Pages 1272-1285
The Spine Journal

Review Article
Anxiety and depression in spine surgery—a systematic integrative review

https://doi.org/10.1016/j.spinee.2018.03.017Get rights and content
Under a Creative Commons license
open access

Abstract

Background

Symptoms of preoperative anxiety and depression occur in approximately one-third of patients with chronic back pain undergoing surgery. In the last 2 decades, several studies have established that preoperative anxiety and depression are important outcome predictors of greater pain and physical impairments, and lower health-related quality of life in patients undergoing spine surgery. To accommodate symptoms of anxiety and depression and thereby better surgical outcomes, we need to identify factors associated with these symptoms.

Purpose

We aimed to identify factors associated with symptoms of anxiety and depression in adults both before and after undergoing spinal surgery.

Study Design

An integrative literature review was carried out.

Methods

The independent charity Helsefonden supported this literature review by contributing $45,000 to remunerate a dedicated investigator. A systematic literature search was conducted in PubMed, CINAHL, PsycINFO, Embase, Scopus, Cochrane, and Web of Science. A three-step selection and assessment process was conducted; titles and abstracts of 1,124 articles were skimmed for relevance and of these, 53 articles were found to be of relevance and were read in full. Articles not meeting the inclusion criteria (n=26) were excluded. The 31 articles were critically appraised for methodological validity; 14 of these were synthesized and analyzed using a convergent qualitative design to transform both qualitative and quantitative articles into qualitative findings.

Results

Fourteen studies were included, reporting results based on 4,833 participants, 3,017 men and 1,816 women, whose mean age was approximately 49 years. From these results, we extracted 75 individual findings, which we then divided into five categories of factors associated with anxiety and depression both before and after undergoing spine surgery: pain, information, disability, employment, and mental health.

Conclusions

Five categories of interacting factors that influenced symptoms of anxiety and depression both before and after surgery were identified: pain, lack of information, disability, return to work, and mental health. Information appears to have a regulating effect on anxiety and depression.

Keywords

Anxiety
Convergent qualitative design
Depression
Information
Integrative review
Spine surgery

Cited by (0)

FDA device/drug status: Not applicable.

Author disclosures: JS: Grant: Independent charity Helsefonden (E, Paid directly to institution), pertaining to the submitted work. MBB: Nothing to disclose. CVN: Nothing to disclose. CNT: Nothing to disclose. TLN: Nothing to disclose. ML: Nothing to disclose. LBJ: Nothing to disclose.

The disclosure key can be found on the Table of Contents and at www.TheSpineJournalOnline.com.