Trajectories of anxiety and depression levels in older adult patients undergoing total hip arthroplasty

Table 1 Participants’ demographic and clinical characteristics

	n	%
Age (year; mean ± SD)	69.84 ± 3.98	-
Age (year; min-max)	65-79	-
Composition of age (year)
< 70	119	57.21
70-79	89	42.79
Sex
Female	142	68.27
Male	66	31.73
Degree of education
≤ High school	98	47.12
> High school	110	52.88
Mode of living
Live with spouse	114	54.80
Live with children	73	35.10
Live alone	21	10.10

Table 2 Participants surgical indicators

	n	%
Surgical types
Osteoarthritis	104	50.00
Femoral neck fracture	73	35.10
Avascular necrosis of the femoral head	31	14.90
Anesthesia types
Epidural anesthesia	125	60.10
General anesthesia	83	39.90
Intraoperative blood loss (mL; mean ± SD)	344.36 ± 115.17	-
Intraoperative blood loss (mL; min-max)	65-598	-
Composition of intraoperative blood loss (mL)
< 200	28	13.46
200-500	163	78.37
> 500	17	8.17
Surgical duration (minute; mean ± SD)	103.58 ± 23.01	-
Surgical duration (min-max)	44-196	-
Composition of surgical duration (minute)
< 90	55	26.44
90-120	110	52.89
> 120	43	20.67

Table 3 Participants’ Visual Analog Scale and General Self-Efficacy Scale

	Time	Score
VAS	T0	3.08 ± 1.13
	T1	6.39 ± 1.05a
	T2	2.51 ± 1.14a,b
	T3	1.75 ± 0.80a,b,c
	F	808.024
	P value	< 0.001
GSES	T0	22.08 ± 4.94
	T1	24.12 ± 5.58a
	T2	26.95 ± 3.98a,b
	T3	29.01 ± 4.57a,b,c
	F	84.203
	P value	< 0.001

^aP < 0.05 vs 3 days before operation.

^bP < 0.05 vs 1 week after the procedure.

^cP < 0.05 vs 1 month after the procedure.

T0: 3 days before operation; T1: 1 week after the procedure; T2: 1 month after the procedure; T3: 3 months after the procedure. VAS: Visual Analog Scale; GSES: General Self-Efficacy Scale.

Table 4 Participants’ Social Support Rating Scale

SSRS	Score
Objective support score	13.83 ± 4.13
Subjective support dimension	18.01 ± 6.14
Utilization support dimension	10.31 ± 6.93
Total score	42.16 ± 10.32

SSRS: Social Support Rating Scale.

Table 5 Participants’ Hamilton Anxiety Rating Scale and Hamilton Rating Scale for Depression-17 items scores, mean ± SD or n (%)

	Time	Score	Mild depression/anxiety rate	Moderate depression/anxiety rate
HAMA	T0	10.41 ± 3.14	180 (86.54)	7 (3.37)
	T1	14.95 ± 4.31a	125 (60.10)	78 (37.50)
	T2	10.04 ± 2.85b,c	181 (87.02)	4 (1.92)
	T3	7.28 ± 2.07a,b,c	136 (65.38)	0 (0.00)
	F	205.716
	P value	< 0.001
HAMD-17	T0	11.55 ± 2.53	202 (97.12)	2 (0.96)
	T1	16.00 ± 3.19a	121 (58.17)	87 (41.83)
	T2	10.88 ± 3.06a,b	190 (91.35)	4 (1.92)
	T3	6.83 ± 1.97a,b,c	111 (53.37)	0 (0.00)
	F	393.407
	P value	< 0.001

^aP < 0.05 compared with 3 days before operation.

^bP < 0.05 compared with 1 week after the procedure.

^cP < 0.05 compared with 1 month after the procedure.

T0: 3 days before operation; T1: 1 week after the procedure; T2: 1 month after the procedure; T3: 3 months after the procedure. Hamilton Anxiety Rating Scale (HAMA) 7-16 points: Mild anxiety rate; HAMA 17-24 points: Moderate anxiety rate; Hamilton Rating Scale for Depression (HAMD) 7-17 points: Mild depression rate; HAMD-17 17-24 points: Moderate depression. HAMA: Hamilton Anxiety Rating Scale; HAMD: Hamilton Rating Scale for Depression.

Table 6 Comparison of the fitting results

Categories	AIC	BIC	Entropy	LMR-LRT (P value)	Rationality of classification
1	3256.8	3289.2	-	-	A single column cannot highlight heterogeneity
2	2891.2	2952.9	0.85	0.04	2 columns: Stable group (89 cases), unstable group (119 cases)
3	2984.6	3034.6	0.82	0.08	3 columns: Low-risk group (89 cases), medium-risk group (97 cases), high-risk group (22 cases)
4	2875.6	2952.0	0.76	0.12	4 columns: Only 7 cases of 1 class, and stability was poor

AIC: Akaike information criterion; BIC: Bayesian information criterion; LMR-LRT: Lo-Mendell-Rubin likelihood ratio test.

Table 7 Univariate analysis of factors influencing the trajectory of anxiety and depression, mean ± SD or n (%)

	Stable group (n = 89)	Unstable group (n = 119)	t/χ2	P value
Age (year)	67.57 ± 1.86	71.54 ± 4.29	8.158	< 0.001
Sex			0.952	0.329
Female	64 (71.91)	78 (65.55)
Male	25 (28.09)	41 (34.45)
Degree of education			15.603	< 0.001
High school and below	56 (62.92)	42 (35.29)
High school above	33 (37.08)	77 (64.71)
Mode of living			0.288	0.866
Live with spouse	47 (52.81)	67 (56.30)
Live with children	33 (37.08)	40 (33.61)
Live alone	9 (10.11)	12 (10.08)
Surgical types			0.675	0.714
Osteoarthritis	42 (47.19)	62 (52.10)
Femoral neck fracture	32 (35.96)	41 (34.45)
Avascular necrosis of the femoral head	15 (16.85)	16 (13.45)
Anesthesia types			1.012	0.315
Epidural anesthesia	57 (64.04)	68 (57.14)
General anesthesia	32 (35.96)	51 (42.86)
Intraoperative blood loss (mL)	355.60 ± 112.11	335.96 ± 117.17	1.218	0.225
Surgical duration (minutes)	100.66 ± 24.60	105.76 ± 21.60	1.588	0.114
VAS	5.98 ± 0.77	6.71 ± 1.12	5.266	< 0.001
GSES	26.47 ± 4.61	22.35 ± 4.63	5.649	< 0.001
SSRS	46.48 ± 4.66	41.11 ± 7.65	5.862	< 0.001

VAS: Visual Analog Scale; GSES: General Self-Efficacy Scale; SSRS: Social Support Rating Scale.

Table 8 Multivariate analysis of influencing anxiety and depression trajectory

	β	SE	Wald χ2	P value	Exp (B)	95%CI
						Lower limit	Upper limit
Age	0.401	0.079	25.787	< 0.001	1.493	1.279	1.743
VAS	0.65	0.222	8.591	0.003	1.916	1.24	2.959
GSES	-0.092	0.04	5.276	0.022	0.912	0.843	0.987
SSRS	-0.112	0.033	11.707	0.001	0.894	0.839	0.953
Degree of education	1.236	0.428	8.33	0.004	3.440	1.487	7.962

VAS: Visual Analog Scale; GSES: General Self-Efficacy Scale; SSRS: Social Support Rating Scale.