The increased need for liaison psychiatry in surgical patients due to the high prevalence of undiagnosed anxiety and depression

Abstract

Anxiety and depression are highly prevalent in surgical inpatients. An increased awareness of the possibility of undiagnosed psychiatric disorders is required, along with prompt and appropriate use of liaison psychiatry services.

Why are hospital doctors not referring to Consultation-Liaison Psychiatry? – a systemic review

“…Mezey and Kellet’s survey revealed that surgeons and gynaecologists were less likely to refer than their medical physician counterparts [33]. This was supported by reviews of referrals by surgical, obstetric and gynaecological doctors in several studies [52, 53]. Collating findings of Cohen-Cole and Friedman’s study with Mezey and Kellet’s, lower referral rates from surgeons, obstetricians and gynaecologists may be a result of poorer recognition of psychiatric issues.…”

“…Young age, functional psychosis associated with increased referral. Organic psychosis and previous psychiatric contact associated with decreased referral.Caplan et al 2008 [38]USN/AOpinion pieceWork pressure suggested with increased CLP referralsWood & Bisson 2004 [39]UK, maxillofacial surgery unit58 patients with cancers of head and neckSubjective reporting of experience with mental health nurse liaisonIncreased referrals suggested with use of mental health nurse liaison.Cohen-Cole et al 1982 [40]US, North Carolina Memorial Hospital407 hospital doctors (34 % response rate)37 item questionnairePhysicians in internal medicine and family medicine tend to recognise patients with more psychological issues.Most hospital doctors are comfortable with managing psychiatric illness.Lin et al 2011 [52]Taiwan, general hospital111 obstetric and gynaecologic patientsRetrospective chart reviewLow referral rates from obstetric and gynaecologic department.Ni Mhaolain et al 2008 [53]Ireland, general hospital96 surgical patientsProspective evaluation of anxiety and depression in surgical patientsHigh prevalence of depression and anxiety in surgical patients.Balestrieri et al 2002 [54]Italy, general hospital1039 general inpatientsCross sectional investigation of prevalence of depression among hospital patientsIdentification of depression by hospital doctors in one third of all cases.Fauman 1983 [55]US, private urban hospital265 hospital doctors (41.9 % response rate)66 item questionnaireInternists are more willing to refer suicidal attempts than surgeons. Internists are more willing to ask for consultations than surgeons for all other mental health conditions.Hamdieh et al 2015 [41]Iran, Tehran, general hospital300 non-psychiatric doctors (64.3 % response rate)8 item questionnaireHospital doctors were more comfortable requesting for psychiatric consultations than managing psychiatric conditions themselves.Jourdan & Glickman 1991 [57]US, general hospital380 psychiatric referralsRetrospective chart reviewHigh referral rates for determination of competency.…”

Factors Associated with Psychological Distress at Home following Elective Surgery in a Representative Group of Surgical Patients: An Explorative Panel Study

“…The findings of this study suggest that a sizeable proportion, or almost 10%, of surgical patients experience psychological disturbances, as measured with HADS, both at hospital and at home. Studies that have used HADS in various surgical patient populations have reported even larger proportions of their samples with psychological disturbances (3,(9)(10). This and the detrimental effects of untreated depression (4,22) supports the need for nurses working with post-op patients to develop tools to screen patients during hospital stay that need psychological intervention or a follow up postdischarge.…”

“…It is well documented that prospective surgery can cause anxiety that may last for several weeks prior to surgery and influence the whole recovery period including postoperative pain, length of hospital stay, symptoms in general and patient satisfaction (5)(6)(7)(8). Prevalence of undiagnosed anxiety and depression in surgical inpatients has been found to range from 12.5% to 32.8% (9)(10).…”

Hirurški bolesnici sa psihičkim tegobama

“…Prospektivna studija dva hirurška odeljenja u Irskoj zabeležila je tešku depresiju kod 12.5% pacijenata, značajnu generalizovanu anksioznost kod 19%, a mešanu anksioznost i depresiju visokog stepena kod 8% hospitalizovanih. (2) Hirurški pacijenti često imaju prethodna psihijatrijska oboljenja, a veliki broj psihičkih tegoba mogu postati evidentni u periodu posle operacije. Prevalenca ovih simptoma kod hirurških pacijenata je 15-50%, a oni često ostaju nedijagnostikovani.…”