Influencing Factors Of Anxiety And Depression In Patients With Pulmonary Nodules Before And After Operation

Objective:The paper studied the incidence of anxiety and depression thought the period time before and after surgery for the patient of pulmonary nodules(tumor dimeter?3cm),and analyzed potential elements related to anxiety and depression to get more and better knowledge on patients' physical and mental status so as to figure out a better and proper treatment plan for expecting treatment performance.Methods: The study objects covered all patients of pulmonary nodules hospitalized and received surgery treatment in Thoracic Surgery Department of our hospital from Oct.2015 to Dec.2017.The patients' basic information and clinic elements include age,gender,body mass index(BMI),smoking history(never smoker and former smoker),alcohol drinking frequency(more than twice weekly),financial situation,ward size,surgery numbers,pulmonary performance,comorbidities(hypertension,diabetes,phthisis,liver disease,end stage renal disease,coronary artery disease,arthritis and chronic obstructive pulmonary disease),clinical stages,histology(adenocarcinoma,squamous cell carcinoma etc.),social factors(marriage condition,education level divided into such four levels as primary level,junior level,senior level,college and above level),operation variables(like type of operation,type of resection and postoperative complications including pneumonia,acute respiratory distress syndrome,cerebrovascular accident,wound problems,empyema,chylothorax,chronic air leak for over 1 week,Long term pleural effusion over 1 week,arrhythmia,vocal cord paralysis),and subjective postoperative physical symptoms(pain and difficulty breathing).It was separately assessed by quantitative test form at the day before surgery and one-month late day to patients for the incidence of anxiety and depression so as to analysis the influence factors.The study excluded their complex treatment history(history of other cancer treatment,history of recurrent or metastatic lung cancer or neoadjuvant therapy)and psychotropic medication.The Zung's Anxiety and Depression test form was adopted to decide the degree of preoperative and postoperative anxiety and depression,and conclude the risk elements on it.Results: It was a total of 138 involved patients of an average age 61,among which 135 cases(98% of total number)was thoracoscopic surgery and 3 cases(2%)was traditional thoracotomy.The rate of preoperative anxiety and depression were 26%(36 cases)and 9%(12 cases)respectively,and postoperative anxiety and depression were 28%(39 cases)and 17%(n= 23)),P = 0.68 and <0.050,respectively.It was found that gender,age,marriage situation,alcohol drinking frequency,smoking,lung performance,employment status,tumor type and clinical stage is non-related to anxiety and depression.Multivariate analysis showed that body mass index(OR =1.20,P = 0.039),surgery numbers and ward size(OR = 22.50,P <0.001)are risk factors influencing preoperative anxiety,meanwhile the Diabetes(OR = 0.01,P <0.001)and arthritis(OR = 0.10,P = 0.005)were the factors affecting preoperative depression;the postoperative dyspnea(OR = 4.60,P = 0.001),severe pain(OR = 4.00,P = 0.001)and preoperative anxiety(OR = 0.09,P = 0.009)are the factors affecting postoperative anxiety,and Postoperative complications(OR = 4.60,P = 0.031),severe pain(OR =5.40,P = 0.002),hypertension(OR = 0.11,P=0.032),Preoperative depression(OR = 0.01,P = 0.032)affecting postoperative depression.18patients(29%)agreed and were offered supportive psychotherapy or psychiatric medication,including antidepressants and anti-anxiety medicine;44 patients with abnormal scores(71%)refused psychiatric clinics or psychiatric visits.10 patients(56%)were diagnosed with moderate anxiety;2 persons(11%)were severe anxiety;and 6 were moderate depression(33%).Conclusion: The main influencing factors of preoperative anxiety on patients with pulmonary nodules were surgery numbers,ward size and body mass index;that of depression are diabetes,arthritis,low educational level.Postoperative psychological distress after surgery,especially depression present increasing tendency.Postoperative residual pain,difficulty breathing and postoperative comorbidities aggravate postoperative anxiety and depression.Carefully mental assessment and appropriate management is necessary to improve its quality of life after lung cancer surgery.