Is the Hospital Anxiety and Depression Scale Associated With Outcomes After Lumbar Spine Surgery?

Abstract

Study Design: Longitudinal cohort. Objectives: The Hospital Anxiety and Depression Scale (HADS) was developed to provide clinicians a reliable, valid, and practical tool to identify and quantify the anxiety and depression in medical patients. Several studies have shown that patients with chronic low back pain may have subclinical depression and impairments in mental health and that these in turn may lead to less than optimal results after lumbar spine surgery. The purpose of this study is to determine if there are associations between preoperative HADS and differences in pre- and postoperative health-related quality-of-life (HRQOLs) scores after spine surgery. Methods: From a single center, a consecutive series of patients completed the HADS, Oswestry Disability Index (ODI), Short Form-36 (SF-36), EuroQOL-5D (EQ-5D), and Visual Analog Scale (VAS) for back and leg pain. Except for HADS, the patients completed the same HRQOLs 1 year after surgery. Results: Of 308 eligible cases, 208 (68%) had follow-up data available and were included in the analysis. Patients in the HADS-Anxiety (HADS-A) Abnormal category had the worst preoperative HRQOLs but had the greatest improvement in 1-year postoperative scores. Except for VAS Leg Pain, preoperative HRQOLs were better in patients in the HADS-Depressed (HADS-D) Normal category. Patients in the HADS-D Abnormal category had statistically significantly greater improvement in 1-year postoperative EQ-5D and ODI scores when compared with the other cohorts. Conclusion: Worse HADS-A and HADS-D scores are associated with worse preoperative HRQOL scores in patients with lumbar degenerative disorders scheduled for spine surgery. However, similar improvements in HRQOLs can be expected 1 year postoperative regardless of the patients’ HADS scores.

Prevalence and Outcomes of Major Psychiatric Disorders Preceding Index Surgery for Degenerative Thoracic/Lumbar Spine Disease

“…Compared with the controls, patients with anxiety disorder had 0.77-fold lower odds of extended hospitalization stays without significant differences of in-hospital or post-discharge outcomes. Although previous studies found that among patients with degenerative thoracic or lumbar spine disease, neither preoperative depression nor anxiety is correlated with improvement of postoperative outcomes such as life quality, physical functioning, or perceived pain [ 44 , 45 ]. The finding may hint that patients with anxiety mood disorder had favorable surgical outcomes than those with mood disorder.…”

Validation of the Subgroups for Targeted Treatment for Back (STarT Back) screening tool at a tertiary care centre

“…The HADS has acceptable measurement properties in patients with musculoskeletal conditions 27 and low back pain. 28 – 30 …”

Effect of COVID-19 on quality of life of persons aged >70 years with adult spinal deformity: A cross-sectional case-control study

“…Each dimension has 3 levels of severity (no problems, some problems, and severe problems). The EQ VAS is used to record the self-reported health status on a vertical VAS where the endpoints are labeled “The best health you can imagine” and “The worst health you can imagine.” [ 10 , 11 ]…”

“…The EQ VAS is used to record the self-reported health status on a vertical VAS where the endpoints are labeled "The best health you can imagine" and "The worst health you can imagine." [10,11] The GDS is one of the most widely used instruments for identifying depression in elderly persons. It comprises 15 dichotomous questions (yes/no), of which 10 are positive and 5 are negative.…”