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International Journal of Behavioral Medicine
Published in: International Journal of Behavioral Medicine 6/2018

01-12-2018

Social Relationship Factors, Preoperative Depression, and Hospital Length of Stay in Surgical Patients

Authors: Henning Krampe, Anke Barth-Zoubairi, Tatjana Schnell, Anna-Lena Salz, Léonie F. Kerper, Claudia D. Spies

Published in: International Journal of Behavioral Medicine | Issue 6/2018

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Abstract

Purpose

The interrelated associations of social relationship factors, depression, and outcomes of surgical patients are yet unexplored. The purpose of this study was to investigate whether depression mediates effects of general social support, loneliness, and living alone on hospital length of stay (LOS) of 2487 patients from diverse surgical fields.

Method

Social relationship factors and depression were assessed prior to surgery. The PROCESS macro for SPSS was used to conduct three simple mediation models that tested the indirect effects of social relationship factors on LOS mediated through depression. The models were adjusted for age, gender, preoperative physical health, surgical field, severity of medical comorbidity, and extent of surgical procedure.

Results

Social support and loneliness had significant indirect effects on LOS that were statistically mediated by preoperative depression. Lower social support and the feeling of loneliness were considerably related to higher depression which predicted longer LOS. While social support and loneliness had no direct effects on LOS, there was a small significant direct association of living alone with shorter LOS.

Conclusion

Data suggest that social support and loneliness are indirectly related with surgical outcomes by an association with depression which in turn is related to worse outcomes.

Trial Registration

NCT01357694
Literature
1.
2.
Eisenberger N. An empirical review of the neural underpinnings of receiving and giving social support: implications for health. Psychosom Med. 2013;75:545–56.CrossRefPubMedPubMedCentral
3.
4.
Holt-Lunstad J, Smith T, Baker M, Harris T, Stephenson D. Loneliness and social isolation as risk factors for mortality: a meta-analytic review. Perspect Psychol Sci. 2015;10(2):227–37.CrossRefPubMed
5.
Holt-Lunstad J, Smith T. Loneliness and social isolation as risk factors for CVD: implications for evidence-based patient care and scientific inquiry. Heart. 2016;102(13):987–9.CrossRefPubMed
6.
Marroquín B. Interpersonal emotion regulation as a mechanism of social support in depression. Clin Psychol Rev. 2011;31:1276–90.CrossRefPubMed
7.
Santini Z, Koyanagi A, Tyrovolas S, Mason C, Haro J. The association between social relationships and depression: a systematic review. J Affect Disord. 2015;175:53–65.CrossRefPubMed
8.
Stickley A, Koyanagi A. Loneliness, common mental disorders and suicidal behavior: findings from a general population survey. J Affect Disord. 2016;197:81–7.CrossRefPubMed
9.
Thoits P. Mechanisms linking social ties and support to physical and mental health. J Health Soc Behav. 2011;52(2):145–61.CrossRefPubMed
10.
Uchino B. Social support and health: a review of physiological processes potentially underlying links to disease outcomes. J Behav Med. 2006;29(4):377–87.CrossRefPubMed
11.
Uchino B, Bowen K, McKenzie C, Birmingham W. Psychological pathways linking social support to health outcomes: a visit with the “ghosts” of research past, present, and future. Soc Sci Med. 2012;74:949–57.CrossRefPubMedPubMedCentral
12.
Valtorta N, Kanaan M, Gilbody S, Ronzi S, Hanratty B. Loneliness and social isolation as risk factors for coronary heart disease and stroke: systematic review and meta-analysis of longitudinal observational studies. Heart. 2016;102(13):1009–16.CrossRefPubMed
13.
Pinquart M, Duberstein P. Associations of social networks with cancer mortality: a meta-analysis. Crit Rev Oncol Hematol. 2010;75:122–37.CrossRefPubMed
14.
Livhits M, Mercado C, Yermilov I, Parikh J, Dutson E, Mehran A, et al. Is social support associated with greater weight loss after bariatric surgery? A systematic review. Obes Rev. 2011;12:142–8.CrossRefPubMed
15.
Luttik M, Jaarsma T, Moser D, Sanderman R, van Veldhuisen D. The importance and impact of social support on outcomes in patients with heart failure: an overview of the literature. J Cardiovasc Nurs. 2005;20(3):162–9.CrossRefPubMed
16.
Gariépy G, Honkaniemi H, Quesnel-Vallée A. Social support and protection from depression: systematic review of current findings in Western countries. Br J Psychiatry. 2016;209:284–93.CrossRefPubMed
17.
Evans D, Charney D, Lewis L, Golden R, Gorman J, Krishnan K, et al. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry. 2005;58:175–89.CrossRefPubMed
18.
Sotelo J, Nemeroff C. Depression as a systemic disease. Pers Med Psychiatry. 2017;1-2:11–25.
19.
Rosenberger PH, Jokl P, Ickovics J. Psychosocial factors and surgical outcomes: an evidence-based literature review. J Am Acad Orthop Surg. 2006;14(7):397–405.CrossRefPubMed
20.
Linnen H, Krampe H, Neumann T, Weiss-Gerlach E, Heinz A, Wernecke K-D, et al. Depression and essential health-risk factors in surgical patients in the preoperative anesthesiological assessment clinic. Eur J Anaesthesiol. 2011;28(10):733–41.CrossRefPubMed
21.
Kerper LF, Spies CD, Buspavanich P, Balzer F, Salz A-L, Tafelski S, et al. Preoperative depression and hospital length of stay in surgical patients. Minerva Anestesiol. 2014;80(9):984–91.PubMed
22.
Orri M, Boleslawski E, Regimbeau J, Barry C, Hassler C, Gregoire E, et al. Influence of depression on recovery after major noncardiac surgery. Ann Surg. 2015;262(5):882–90.CrossRefPubMed
23.
Kim S, Duncan P, Groban L, Segal H, Abbott R, Williamson J. Patient-reported outcome measures (PROM) as a preoperative assessment tool. J Anesth Perioper Med. 2017;4(6):274–81.CrossRefPubMedPubMedCentral
24.
Graven L, Grant J. The impact of social support on depressive symptoms in individuals with heart failure: update and review. J Cardiovasc Nurs. 2013;28(5):429–43.CrossRefPubMed
25.
Laderman M, Mate K. Behavioral health integration in acute medical settings: an opportunity to improve outcomes and reduce costs. Jt Comm J Qual Patient Saf. 2016;42(7):331–6.CrossRefPubMed
26.
Contrada RJ, Boulifard DA, Hekler EB, Idler EL, Spruill TM, Labouvi EW, et al. Psychosocial factors in heart surgery: presurgical vulnerability and postsurgical recovery. Health Psychol. 2008;27(3):309–19.CrossRefPubMed
27.
Contrada RJ, Goyal TM, Cather C, Rafalson L, Idler EL, Krause TJ. Psychosocial factors in outcomes of heart surgery: the impact of religious involvement and depressive symptoms. Health Psychol. 2004;23:227–38.CrossRefPubMed
28.
29.
Sorensen EA, Wang F. Social support, depression, functional status, and gender differences in older adults undergoing first-time coronary artery bypass graft surgery. Heart Lung. 2009;38:306–17.CrossRefPubMed
30.
Krohne H, Slangen K. Influence of social support on adaptation to surgery. Health Psychol. 2005;24(1):101–5.CrossRefPubMed
31.
32.
Cacioppo JT, Cacioppo S. Social relationships and health: the toxic effects of perceived social isolation. Soc Personal Psychol Compass. 2014;8(2):58–72.CrossRefPubMedPubMedCentral
33.
34.
Cacioppo JT, Cacioppo S, Capitanio JP, Cole SW. The neuroendocrinology of social isolation. Annu Rev Psychol. 2015;66:733–67.CrossRefPubMed
35.
Heinrich L, Gullone E. The clinical significance of loneliness: a literature review. Clin Psychol Rev. 2006;26:695–718.CrossRefPubMed
36.
Kerper LF, Spies CD, Salz A-L, Weiß-Gerlach E, Balzer F, Neumann T, et al. Effects of an innovative psychotherapy program for surgical patients - bridging intervention in anesthesiology: a randomized controlled trial. Anesthesiology. 2015;123(1):148–59.CrossRefPubMed
37.
38.
Zigmond A, Snaith R. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–70.CrossRefPubMed
39.
Herrmann C, Buss U, Snaith R. HADS-D Hospital Anxiety and Depression Scale: Deutsche Version. Bern: Verlag Hans Huber; 1995.
40.
Smarr KL, Keefer AL. Measures of depression and depressive symptoms: Beck Depression Inventory-II (BDI-II), Center for Epidemiologic Studies Depression Scale (CES-D), Geriatric Depression Scale (GDS), Hospital Anxiety and Depression Scale (HADS), and Patient Health Questionnaire-9 (PHQ-9). Arthritis Care Res. 2011;63(S11):S454–S66.CrossRef
41.
Brennan C, Worrall-Davies A, McMillan D, Gilbody S, House A. The hospital anxiety and depression scale: a diagnostic meta-analysis of case-finding ability. J Psychosom Res. 2010;69:371–8.CrossRefPubMed
42.
Schulz U, Schwarzer R. Soziale Unterstützung bei der Krankheitsbewältigung: die Berliner social support Skalen (BSSS) [social support in coping with illness: the berlin social support scales]. Diagnostica. 2003;49(2):73–82.CrossRef
43.
American Society of Anesthesiologists. New classification of physical status. Anesthesiology. 1963;24:111.
44.
Wolters U, Wolf T, Stuetzer H, Schröder T. ASA classification and perioperative variables as predictors of postoperative outcome. Br J Anaesth. 1996;77:217–22.CrossRefPubMed
45.
Lange LF, Spies CD, Weiß-Gerlach E, Neumann T, Salz A-L, Tafelski S, et al. Bridging intervention in anaesthesiology: first results on treatment need, demand and utilization of an innovative psychotherapy program for surgical patients. Clin Health Promot. 2011;1(2):41–9.
46.
Kerper LF, Spies CD, Lößner M, Salz A-L, Tafelski S, Balzer F, et al. Persistence of psychological distress in surgical patients with interest in psychotherapy: results of a 6-month follow-up. PLoS One. 2012;7:e51167.CrossRefPubMedPubMedCentral
47.
Charlson ME, Pompei P, Ales K, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed
48.
Quan H, Sundararajan V, Halfon P, Fong A, Burnand B, Luthi J-C, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–9.CrossRefPubMed
49.
Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78:356–60.CrossRef
50.
Noordzij PG, Poldermans D, Schouten O, Bax JJ, Schreiner FAG, Boersma E. Postoperative mortality in the Netherlands: a population-based analysis of surgery-specific risk in adults. Anesthesiology. 2010;112:1105–15.CrossRefPubMed
51.
52.
Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press; 2013.
53.
Hayes AF, Rockwood NJ. Regression-based statistical mediation and moderation analysis in clinical research: observations, recommendations, and implementation. Behav Res Ther. 2017;98:39–57.CrossRefPubMed
54.
Tabachnick BG, Fidell LS. Using multivariate statistics. 4th ed. Boston: Allyn & Bacon; 2001.
55.
56.
Beresnevaite M, Rimantas B, Taylor G, Jureniene K, Kinduris S, Barauskiene V. Depression predicts perioperative outcomes following coronary artery bypass graft surgery. Scand Cardiovasc J. 2010;44:289–94.CrossRefPubMed
57.
Oxlad M, Stubberfield J, Stuklis R, Edwards J, Wade T. Psychological risk factors for increased post-operative length of hospital stay following coronary artery bypass graft surgery. J Behav Med. 2006;29(2):179–90.CrossRefPubMed
58.
Törer N, Nursal TZ, Caliskan K, Ezer A, Colakoglu T, Moray G, et al. The effect of the psychological status of breast cancer patients on the short-term clinical outcome after mastectomy. Acta Chir Belg. 2010;110:467–70.CrossRefPubMed
59.
Kitagawa R, Yasui-Furukoi N, Tsushima T, Kaneko S, Fukuda I. Depression increases the length of hospitalization for patients undergoing thoracic surgery: a preliminary study. Psychosomatics. 2011;52:428–32.CrossRefPubMed
60.
61.
Fokkema T, De Jong Gierveld J, Dykstra PA. Cross-national differences in older adult loneliness. Aust J Psychol. 2012;146(1–2):201–28.CrossRef
Metadata
Title
Social Relationship Factors, Preoperative Depression, and Hospital Length of Stay in Surgical Patients
Authors
Henning Krampe
Anke Barth-Zoubairi
Tatjana Schnell
Anna-Lena Salz
Léonie F. Kerper
Claudia D. Spies
Publication date
01-12-2018
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 6/2018
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-018-9738-8

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