PSYCHIATRIC DISTURBANCE AND ACUTE STRESS RESPONSES IN SURGICAL PATIENTS

Background: A number of reports have appeared of post-traumatic stress symptoms occurring in physically ill patients. This study sought to m easure the extent of psychiatric disturbance and acute post-traumatic stress reactions occurring in surgical inpatients, and to examine thei r relationship with the stress of illness and hospitalization and the personal coping style of the patient. Methods: Thirty-seven admissions to a general surgical unit were assessed on admission and immediately prior to discharge. Measures were made of depression, anxiety, cognit ive impairment, post-traumatic stress symptoms, severity of illness, l evel of physical functioning, degree of hospital stress and coping sty le. Results: There was a significant reduction in anxiety scores posto peratively. Twenty-seven per cent of patients developed high levels of acute post-traumatic stress symptoms and these correlated with depres sion at admission and intra-hospital stress. Depression at discharge w as related to depression at admission, physical functioning and coping style. In general, avoidance and acceptance-resignation were associat ed with a poorer psychiatric outcome. Conclusions: Postoperative psych iatric disturbance, including acute stress symptoms, can be understood as a reaction to the 'trauma' of illness and hospitalization, predisp osed to by pre-existing depression. Interventions could be directed at screening for at-risk patients, minimizing stress, and encouraging ad aptive mechanisms of coping in patients.