Psychiatric disturbance and acute stress responses in surgical patients

Aust N Z J Surg. Feb-Mar 1997;67(2-3):115-8. doi: 10.1111/j.1445-2197.1997.tb01914.x.


Background: A number of reports have appeared of post-traumatic stress symptoms occurring in physically ill patients. This study sought to measure the extent of psychiatric disturbance and acute post-traumatic stress reactions occurring in surgical inpatients, and to examine their 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, cognitive impairment, post-traumatic stress symptoms, severity of illness, level of physical functioning, degree of hospital stress and coping style.

Results: There was a significant reduction in anxiety scores postoperatively. Twenty-seven per cent of patients developed high levels of acute post-traumatic stress symptoms and these correlated with depression at admission and intra-hospital stress. Depression at discharge was related to depression at admission, physical functioning and coping style. In general, avoidance and acceptance-resignation were associated with a poorer psychiatric outcome.

Conclusions: Postoperative psychiatric disturbance, including acute stress symptoms, can be understood as a reaction to the 'trauma' of illness and hospitalization, predisposed to by pre-existing depression. Interventions could be directed at screening for at-risk patients, minimizing stress, and encouraging adaptive mechanisms of coping in patients.

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Anxiety / epidemiology*
  • Depression / epidemiology*
  • Humans
  • Middle Aged
  • Patient Admission
  • Patient Discharge
  • Severity of Illness Index
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress, Psychological*
  • Surgical Procedures, Operative / psychology*