Postoperative depression and anxiety in patients undergoing intestinal tumor surgery: Incidence, predictors, and impact on quality of life

Table 1 General data of patients, n (%)/mean ± SD

Indicators	Data	χ2/t	P value
Gender (male/female)	70/50	0.833	0.361
Age (years)	64.30 ± 8.20	1.632	0.672
Marital status (married/other)	101/19	0.264	0.607
Educational attainment (high school and above/others)	72/48	0.6	0.439
Occupation type (brain/body/unemployed)	51/42/27	0.916	0.632
Income ≥ 6000 CNY (n)	38	0.423	0.516
Mode of residence (alone/with family)	28/92	0.189	0.664
Type of health insurance (employee/resident/self-paying)	65/43/12	0.211	0.9
Tumor site (small intestine/colon/rectum)	16/69/35	0.391	0.822
TNM staging (I/II/III/IV)	18/37/43/22	0.374	0.828
Surgical (laparoscopic/open)	72/48	0.267	0.606
Ostomy (yes/no)	28/92	0.133	0.715
Intraoperative systolic blood pressure grading, mmHg		2.941	0.032
> 120	38 (31.67)
110-120	45 (37.50)
90-110	28 (23.33)
80-90	9 (7.50)
Intraoperative blood transfusion (yes)	22 (18.33)	1.628	0.202
Operation duration (minute)	182.4 ± 45.3	1.105	0.272
24 hours postoperatively NLR	8.52 ± 3.21	3.872	< 0.001
24 hours postoperatively AFR	10.35 ± 2.68	-2.193	0.03
VAS score	2.30 ± 0.84	2.147	0.034
HAMD score	10.80 ± 3.20	3.209	0.002
SAS score	46.72 ± 5.80	2.891	0.005
SF-36	66.20 ± 8.33	2.671	0.008

P < 0.05 indicated significant difference. TNM: Tumor-node-metastasis; VAS: Visual Analog Scale; HAMD: Hamilton Depression Scale; SAS: Self-Rating Anxiety Scale; NLR: Neutrophil-to-lymphocyte ratio; AFR: Albumin-to-fibrinogen ratio; SF-36: The 36-Item Short Form.

Table 2 Psychological state assessment

Time point	HAMD (score)	χ2/t	P value	SAS (score)	χ2/t	P value
Day 3	10.80 ± 3.20	-	-	46.72 ± 5.80	-	-
Day 7	9.20 ± 3.10	3.271	0.001	44.38 ± 5.40	2.794	0.006
Day 30	7.20 ± 2.60	5.812	< 0.001	41.83 ± 4.90	4.831	< 0.001

P < 0.05 indicated significant difference. HAMD: Hamilton Depression Scale; SAS: Self-Rating Anxiety Scale.

Table 3 Levels of inflammatory factors

Time point	NLR	χ2/t	P value	AFR	χ2/t	P value	PNR	χ2/t	P value
24 hours before surgery	4.21 ± 1.35	-	-	15.20 ± 3.8	-	-	28.5 ± 6.2	-	-
24 hours after surgery	8.52 ± 3.21	15.372	< 0.001	10.35 ± 2.7	12.846	< 0.001	18.3 ± 5.1	16.241	< 0.001
72 hours after surgery	6.83 ± 2.64	5.628	0.003	12.80 ± 3.2	6.213	0.001	22.7 ± 4.9	7.315	0.002

P < 0.05 indicated significant difference. NLR: Neutrophil-to-lymphocyte ratio; AFR: Albumin-to-fibrinogen ratio; PNR: Platelet-to-neutrophil ratio.

Table 4 Nutritional status assessment

Time point	ALB (g/L)	χ2/t	P value	TLC (× 109/L)	χ2/t	P value
Day 3	33.25 ± 3.80	-	-	1.32 ± 0.42	-	-
Day 7	35.18 ± 3.70	3.144	0.002	1.52 ± 0.40	3.009	0.003
Day 30	38.62 ± 3.60	5.821	< 0.001	1.78 ± 0.38	4.823	< 0.001

P < 0.05 indicated significant difference. ALB: Albumin; TLC: Total lymphocyte count.

Table 5 Quality of life assessment

Dimension	Day 3	Day 30	χ2/t	P value	Day 90	χ2/t	P value
PF	55.20 ± 8.40	67.45 ± 7.90	7.342	< 0.001	79.28 ± 6.80	10.114	< 0.001
SF	50.42 ± 7.20	64.31 ± 6.90	9.138	< 0.001	76.84 ± 6.50	12.672	< 0.001
RE	48.63 ± 7.10	61.55 ± 7.00	8.215	< 0.001	73.91 ± 6.20	11.274	< 0.001
BP	48.30 ± 7.10	59.62 ± 6.80	7.141	< 0.001	68.42 ± 6.10	9.314	< 0.001
GH	52.83 ± 7.40	63.28 ± 6.90	6.812	< 0.001	72.46 ± 6.30	8.734	< 0.001
VT	51.20 ± 6.90	60.40 ± 6.60	6.022	< 0.001	70.55 ± 6.10	9.025	< 0.001
MH	50.10 ± 7.30	59.88 ± 6.70	6.141	< 0.001	71.34 ± 6.20	10.311	< 0.001
RP	49.25 ± 6.80	56.31 ± 6.20	5.328	< 0.001	65.24 ± 5.90	7.842	< 0.001

P < 0.05 indicated significant difference. MH: Mental health; RE: Role-emotional; SF: Social function; VT: Vitality; GH: General health; PF: Physical function; RP: Role-physical; BP: Bodily pain.

Table 6 Postoperative complications, n (%)

Types	Day 3	Day 7	Day 30	χ2/t	P value
Incision infection	12 (10.00)	4 (3.33)	1 (0.83)	7.062	0.008
Postoperative haemorrhage	6 (5.00)	0 (0.00)	0 (0.00)	6.316	0.012
Intestinal obstruction	5 (4.17)	3 (2.50)	2 (1.67)	0.82	0.365
Anastomotic leakage	5 (4.17)	2 (1.67)	2 (1.67)	1.136	0.287
Others	28 (23.33)	15 (12.50)	5 (4.17)	15.037	0.001

P < 0.05 indicated significant difference.

Table 7 Subgroup analysis of stoma patients and infection-related psychological scores

Group	HAMD (day 30)	SAS (day 30)	SF-36 (day 30)	P value
Stoma (n = 22)	12.4 ± 3.1	54.2 ± 6.3	58.2 ± 7.1	< 0.001
Non-stoma	6.8 ± 2.5	40.1 ± 4.8	70.3 ± 6.5
Infected	11.2 ± 2.9	52.8 ± 5.9	60.1 ± 6.8	0.032
Non-infected	7.1 ± 2.6	41.5 ± 4.7	69.8 ± 6.4

P < 0.05 indicated significant difference. HAMD: Hamilton Depression Scale; SAS: Self-Rating Anxiety Scale; SF-36: The 36-Item Short Form.

Table 8 Analysis results of mixed-effect model

Indicators	Fixed effect	β	SE	t	P value
HAMD	Time	-1.2	0.15	-8	< 0.001
SAS	Time	-1.1	0.18	-6.11	< 0.001
NLR	Time	-0.85	0.12	-7.08	< 0.001
AFR	Time	1.22	0.2	6.1	< 0.001
SF-36	Time	3.5	0.45	7.78	< 0.001

P < 0.05 indicated significant difference. HAMD: Hamilton Depression Scale; SAS: Self-Rating Anxiety Scale; SF-36: The 36-Item Short Form; NLR: Neutrophil-to-lymphocyte ratio; AFR: Albumin-to-fibrinogen ratio.

Table 9 Results of intermediary effect analysis

Independent variable	Mediator variable	Indirect effect (β)	95%CI	P value
HAMD	NLR	-0.68	-1.05 to -0.35	< 0.001
HAMD	AFR	-0.52	-0.82 to -0.25	0.001
SAS	NLR	-0.61	-0.97 to -0.28	< 0.001
SAS	AFR	-0.47	-0.76 to -0.20	0.003

P < 0.05 indicated significant difference. HAMD: Hamilton Depression Scale; SAS: Self-Rating Anxiety Scale; NLR: Neutrophil-to-lymphocyte ratio; AFR: Albumin-to-fibrinogen ratio.