Medida da ansiedade e da depressão em pacientes no pré-operatório. Estudo comparativo

José Álvaro Marques Marcolino; Fernando Mikio Suzuki; Luís Augusto Cunha Alli; Judymara Lauzi Gozzani; Ligia Andrade da Silva Telles Mathias

doi:10.1590/S0034-70942007000200004

Scientific Article

Medida da ansiedade e da depressão em pacientes no pré-operatório. Estudo comparativo

Measurement of anxiety and depression in preoperative patients. Comparative study

José Álvaro Marques Marcolino; Fernando Mikio Suzuki; Luís Augusto Cunha Alli; Judymara Lauzi Gozzani; Ligia Andrade da Silva Telles Mathias

http://dx.doi.org/10.1590/S0034-70942007000200004 Braz J Anesthesiol, vol.57, n2, p.157-166, 2007

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JUSTIFICATIVA E OBJETIVOS: Os pacientes que vão ser submetidos a um procedimento cirúrgico experimentam ansiedade. A ansiedade e a depressão são os distúrbios mais associados às doenças físicas. Na Escala Hospitalar de Ansiedade e Depressão (HADS) não figuram itens que poderiam estar presentes em doenças físicas e na ansiedade e na depressão. O objetivo deste estudo foi medir a freqüência e o nível da ansiedade e da depressão em pacientes no pré-operatório e em um grupo-controle. MÉTODO: Setenta e nove pacientes internados no Departamento de Cirurgia da Santa Casa de São Paulo e 56 acompanhantes responderam a um questionário de dados sociodemográficos e a HADS. RESULTADOS: A avaliação dos sintomas mostrou que 35 (44,3%) pacientes e 36 (64,3%) acompanhantes foram considerados com ansiedade (teste Exato de Fisher - p = 0,03) e 21 (26,6%) pacientes e 23 (41,1%) acompanhantes foram considerados com depressão (p = 0,09). Com relação ao impacto das variáveis sociodemográficas sobre a medida da ansiedade e da depressão, foi observado apenas que os pacientes desempregados apresentaram nível mais elevado de ansiedade. CONCLUSÕES: Este estudo confirmou a possibilidade do uso da escala HADS de ansiedade e depressão em pacientes cirúrgicos internados. Ele mostrou também que a avaliação da ansiedade no período pré-operatório deve ser realizada, independentemente de o paciente apresentar ou não doença clínica e/ou cirúrgica grave, pois a freqüência de pacientes com ansiedade é relevante e estes merecem algum tipo de cuidado diferenciado no mínimo o uso de medicação ansiolítica antes da intervenção cirúrgica. Foram encontrados níveis muito maiores de ansiedade entre os acompanhantes dos pacientes. Essas pessoas, avaliadas sem que houvesse um concomitante problema clínico, possivelmente demonstraram estar expostas a um considerável nível de estresse, o que resultou em estado ansioso maior do que os pacientes que seriam submetidos a procedimento cirúrgico.

Palavras-chave

AVALIAÇÃO PRÉ-ANESTÉSICA

Abstract

BACKGROUND AND OBJECTIVES: Patients scheduled for surgeries experience anxiety. Anxiety and depression are the disorders most commonly associated with organic diseases. The Hospital Anxiety and Depression Scale (HADS) does not include items that could be present in organic diseases and in anxiety and depression. The objective of this study was to measure the frequency and the level of anxiety and depression in preoperative patients and in a control group. METHODS: Seventy-nine patients admitted to the Surgical Department of Santa Casa de São Paulo and 56 caretakers answered a questionnaire on socio-demographic data and the HADS. RESULTS: The evaluation of the symptoms showed that 35 (44.3%) patients and 36 (64.3%) caretakers had anxiety (Fisher Exact test - p = 0.03) and 21 (26.6%) patients and 23 (41.1%) caretakers had depression (p = 0.09). Regarding the impact of the socio-demographic data on the measurement of anxiety and depression, it was only observed that patients that were unemployed had higher anxiety levels. CONCLUSIONS: This study confirmed that the HADS could be used in hospitalized surgical patients. It also showed that patients should be evaluated preoperatively for anxiety and depression, regardless of the presence of severe clinical and/or surgical disorders, because the frequency of patients with anxiety is relevant and they deserve a differentiated approach - at least the administration of tranquilizers before surgery. Caretakers presented significantly higher levels of anxiety. Those people, evaluated in the absence of concomitant clinical problems, probably demonstrated to be exposed to a considerable level of stress, resulting in a higher anxiety state than the patients scheduled for surgeries.

Keywords

PREANESTHETIC EVALUATION

References

Moffic HS, Paykel ES. Depression in medical-in-patients. Br J Psychiatry. 1975;126:346-353.

Maguire P, Faulkner A, Regnard C. Managing the anxious patient with advancing disease a flow diagram. Palliat Med. 1993;7:239-244.

Maranets I, Kain ZN. Preoperative anxiety and intraoperative anesthetic requirements. Anesth Analg. 1999;89:1346-1351.

Mayou R, Hawton K. Psychiatric disorder in the general hospital. Br J Psychiatry. 1986;149:172-190.

Clarke DM, Minas IH, Stuart GW. The prevalence of psychiatric morbidity in general hospital in patients. Aust N Z J Psychiatry. 1991;25:322-329.

Arolt V, Driessen M, Bangert-Verleger A. Psychiatric disorders in hospitalized internal medicine and surgical patients: Prevalence and need for treatment. Nervenarzt. 1995;66:670-677.

Saravay SM. Psychiatric interventions in the medically ill: Outcome and effectiveness research. Psychiatr Clin North Am. 1996;19:467-480.

Querido A. Forecast and follow-up an investigation into the clinical, social, and mental factors determining the results of hospital treatment. Br J Prev Soc Med. 1959;13:33-49.

Saravay SM, Steinberg MD, Weinschel B. Psychological comorbidity and length of stay in the general hospital. . .

Knights E, Folstein MF. Unsuspected emotional and cognitive disturbance in medical patients. Ann Intern Med. 1977;87:723-734.

Andrade L, Gorenstein C. Escalas de Avaliação Clínica em Psiquiatria e Psicofarmacologia. 2000:139.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361-370.

Kabak S, Halici M, Tuncel M. Functional outcome of open reduction and internal fixation for completely unstable pelvic ring fractures (type C): a report of 40 cases. J Orthop Trauma. 2003;17:555-562.

Vage V, Solhaug JH, Viste A. Anxiety, depression and health-related quality of life after jejunoileal bypass: a 25-year follow-up study of 20 female patients. Obes Surg.. 2003;13:706-713.

Al-Ruzzeh S, Mazrani W, Wray J. J Card Surg. 2004;19:12-16.

Brandberg Y, Arver B, Lindblom A. Preoperative psychological reactions and quality of life among women with an increased risk of breast cancer who are considering a prophylactic mastectomy. . 2004;40:365-374.

Brilstra EH, Rinkel GJ, van der Graaf Y. Quality of life after treatment of unruptured intracranial aneurysms by neurosurgical clipping or by embolisation with coils: A prospective, observational study. Cerebrovasc Dis. 2004;17:44-52.

Christensen FB. Lumbar spinal fusion. Outcome in relation to surgical methods, choice of implant and postoperative rehabilitation. Acta Orthop Scand. ;2004(75):s313.

Keller M, Sommerfeldt S, Fischer C. Recognition of distress and psychiatric morbidity in cancer patients: a multi-method approach. Ann Oncol. 2004;15:1243-1249.

Brady S, Thomas S, Nolan R. Pre-coronary artery bypass graft measures and enrollment in cardiac rehabilitation. J Cardiopulm Rehabil. 2005;25:343-349.

Hobby JL, Venkatesh R, Motkur P. The effect of psychological disturbance on symptoms, self-reported disability and surgical outcome in carpal tunnel syndrome. J Bone Joint Surg Br. 2005;87:196-200.

Gustafsson M, Ahlstrom G. Emotional distress and coping in the early stage of recovery following acute traumatic hand injury: A questionnaire survey. Int J Nurs Stud. 2006;43:557-565.

Johansson M, Thune A, Nelvin L. Randomized clinical trial of day-care versus overnight-stay laparoscopic cholecystectomy. Br J Surg. 2006;93:40-45.

Muszbek K, Szekely A, Balogh EM. Validation of the Hungarian translation of Hospital Anxiety and Depression Scale. . 2006;15:761-766.

Herrmann C. International experiences with the Hospital Anxiety and Depression Scale a review of validation data and clinical results. J Psychosom Res. 1997;42:17-42.

Bjelland I, Dahl AA, Haug TT. The validity of the Hospital Anxiety and Depression Scale: an updated literature review. J Psychosom Res. 2002;52:69-77.

Kliszcz J, Nowicka-Sauer K, Trzeciak B. The level of anxiety, depression and aggression in nurses and their life and job satisfaction. Med Pr. 2004;55:461-468.

Weigl V, Rudolph M, Eysholdt U. Anxiety, depression, and quality of life in mothers of children with cleft lip/palate. Folia Phoniatr Logop. 2005;57:20-27.

Andrews B, Hejdenberg J, Wilding J. Student anxiety and depression: Comparison of questionnaire and interview assessments. J Affect Disord. 2006;95:29-34.

Botega NJ, Bio MR, Zomignani MA. Transtornos de humor em enfermarias de clínica médica e validação de escala de medida (HAD) de ansiedade e depressão. Rev Saúde Publ. 1995;29:355-363.

Norusis MJ. SPSS for windows. Professional statistics. 1993.

Westbrook MT, Viney LL. Age and sex differences in patients reactions to illness. J Health Soc Behav. 1983;24:313-324.

Gentil VF, Lotufo FN. Transtornos de Ansiedade. Manual de Psiquiatria. 1996:168-179.

Magalhães Filho LL, Segurado A, Marcolino JAM. Impacto da avaliação pré-anestésica sobre a ansiedade e a depressão dos pacientes cirúrgicos com câncer. Rev Bras Anestesiol. 2006;56:126-136.

Medida da ansiedade e da depressão em pacientes no pré-operatório. Estudo comparativo

Measurement of anxiety and depression in preoperative patients. Comparative study

José Álvaro Marques Marcolino; Fernando Mikio Suzuki; Luís Augusto Cunha Alli; Judymara Lauzi Gozzani; Ligia Andrade da Silva Telles Mathias

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