Analysis of risk factors for postoperative depressive disorders in patients with intrauterine adhesions

Table 1 Baseline characteristics of the study population, mean ± SD

Feature	Depressed group (n = 112)	Non-depressed group (n = 288)	P value
Age (years)	36.7 ± 4.8	32.4 ± 5.3	< 0.001
Education level (%)	41.1	58.7	0.002
Infertility history (%)	63.4	38.2	< 0.001
Duration of infertility (years)	4.8 ± 2.3	2.9 ± 1.7	< 0.001
Recurrent miscarriage history (%)	42.9	21.5	< 0.001
Preoperative SDS score	48.3 ± 6.7	42.1 ± 5.9	< 0.001
Preoperative HAMD-17 score	14.2 ± 3.8	10.5 ± 3.1	< 0.001
History of depression or anxiety (%)	30.4	9.7	< 0.001
Social support score	34.2 ± 6.8	41.5 ± 7.3	0.001

SDS: Self-Rating Depression Scale; HAMD-17: 17-Item Hamilton Depression Scale.

Table 2 Comparative analysis of demographics, etiology, surgical parameters, and anesthesia type between depressed and non-depressed patients with asherman’s syndrome

Feature	Depressed group (n = 112)	Non-depressed group (n = 288)	P value
Patient demographics
Average age (years, mean ± SD)	36.7 ± 4.8	32.4 ± 5.3	< 0.001
Marital status (%)	75.0	72.9	0.673
Pregnancy history (%)	54.5	65.3	0.044
Etiology of asherman’s syndrome (%)			P = 0.863
Post-abortion curettage	50.9	47.6
Postpartum curettage	23.2	21.9
Hysteroscopic surgery	14.3	16.3
Other causes	11.6	14.2
Classification of asherman’s syndrome (%)
Grade I (mild)	17.9	31.9	0.005
Grade III (severe)	53.6	32.6	< 0.001
Surgical parameters
Average operating time (minutes, mean ± SD)	63.2 ± 18.7	52.4 ± 15.1	< 0.001
Surgical instruments (%)			P = 0.791
Cold scissors	51.8	55.6
Electrosurgical instruments	38.4	35.8
Balloon technique	9.8	8.7
Anti-adhesion barrier use (%)	78.6	69.1	0.043
Anesthesia type (%)			P = 0.327
General anesthesia	66.1	63.2

Table 3 Perioperative outcomes and complications between depressed and non-depressed patients

Feature	Depressed group (n = 112)	Non-depressed group (n = 288)	P value
Surgical time (minutes, mean ± SD)	63.2 ± 18.7	52.4 ± 15.1	< 0.001
Length of hospital stay (days)	3.2 ± 1.1	2.5 ± 0.8	< 0.001
Postoperative complications (%)	17.9 (20/112)	8.0 (23/288)	0.004
Complications (%)
Uterine perforation (%)	3.6	1.4	0.144
Postoperative infection (%)	7.1	3.1	0.068
Severe bleeding requiring intervention (%)	7.1	3.5	0.107
Menstrual recovery within 3 months (%)	61.6 (69/112)	81.6 (235/288)	< 0.001

Table 4 Patients with concurrent medical conditions, mean ± SD

Indicator	Depressed group (n = 112)	Non-depressed group (n = 288)	Between-group P value	Change in depressed group Δ (%)	Change in non-depressed group Δ (%)	P value for change comparison
Psychological assessment
SDS score
Baseline	48.3 ± 6.7	42.1 ± 5.9	< 0.001
3 months postoperative	58.4 ± 7.2	41.8 ± 6.1	< 0.001	+10.1 (20.9)	-0.3 (0.7)	< 0.001
HAMD-17 score
Baseline	14.2 ± 3.8	10.5 ± 3.1	< 0.001
3 months postoperative	20.6 ± 4.9	9.8 ± 3.4	< 0.001	+6.4 (45.1)	-0.7 (6.7)	< 0.001
Quality of life scores (SF-36)
Role-emotional
Baseline	68.5 ± 15.7	78.5 ± 10.7	< 0.001
3 months postoperative	47.8 ± 18.2	62.5 ± 14.7	< 0.001	-20.7 (30.2)	-16.0 (20.4)	< 0.001
Social functioning
Baseline	75.2 ± 14.1	82.5 ± 15.7	< 0.001
3 months postoperative	60.3 ± 15.7	75.1 ± 15.7	< 0.001	-14.9 (19.8)	-7.4 (9.0)	< 0.001
General health
Baseline	70.5 ± 16.3	72.0 ± 15.9	0.372
3 months postoperative	55.2 ± 17.1	71.5 ± 16.2	< 0.001	-15.3 (21.7)	-0.5 (0.7)	< 0.001
Physical functioning
Baseline	80.0 ± 18.5	88.0 ± 17.8	< 0.001
3 months postoperative	65.0 ± 19.2	81.0 ± 18.0	< 0.001	-15.0 (18.8)	-7.0 (8.0)	< 0.001
Role-physical
Baseline	72.0 ± 16.0	74.0 ± 15.5	0.228
3 months postoperative	55.0 ± 17.0	73.5 ± 16.5	< 0.001	-17.0 (23.6)	-0.5 (0.7)	< 0.001
Mental health
Baseline	70.0 ± 14.5	72.0 ± 14.0	0.191
3 months postoperative	50.0 ± 15.5	71.5 ± 14.0	< 0.001	-20.0 (28.6)	-0.5 (0.7)	< 0.001
Vitality
Baseline	65.0 ± 15.0	67.0 ± 14.5	0.213
3 months postoperative	50.0 ± 16.0	66.5 ± 14.5	< 0.001	-15.0 (23.1)	-0.5 (0.7)	< 0.001
Pain
Baseline	75.0 ± 15.0	76.0 ± 14.5	0.541
3 months postoperative	60.0 ± 16.0	75.5 ± 14.5	< 0.001	-15.0 (20.0)	-0.5 (0.7)	< 0.001

Δ represents absolute change from baseline. Percentage change calculated as (postoperative-baseline)/baseline×100%. Higher scores indicate better quality of life for 36-Item Short Form Health Survey domains, while higher Self-Rating Depression Scale and 17-Item Hamilton Depression Scale scores indicate more severe depressive symptoms. SDS: Self-Rating Depression Scale; HAMD-17: 17-Item Hamilton Depression Scale; SF-36: 36-Item Short Form Health Survey.

Table 5 Psychological assessment and quality of life outcomes, mean ± SD

Indicator	Depressed group (n = 112)	Non-depressed group (n = 288)	Between-group difference	P value
Psychological assessment
Preoperative SDS score	48.3 ± 6.7	42.1 ± 5.9	6.2	< 0.001
Postoperative SDS score at 3 months	58.4 ± 7.2	41.8 ± 6.1	16.6	< 0.001
Change in SDS score	+10.1 (20.9%)	-0.3 (0.7%)	10.4	< 0.001
Preoperative HAMD-17 score	14.2 ± 3.8	10.5 ± 3.1	3.7	< 0.001
Postoperative HAMD-17 score at 3 months	20.6 ± 4.9	9.8 ± 3.4	10.8	< 0.001
Change in HAMD-17 score	+6.4 (45.1%)	-0.7 (6.7%)	7.1	< 0.001
Quality of life scores (SF-36)
Baseline role-emotional	68.5 ± 15.7	69.2 ± 16.1	-0.7	0.698
Postoperative role-emotional at 3 months	47.8 ± 18.2	70.1 ± 15.9	-22.3	< 0.001
Change in role-emotional	-20.7 (30.2%)	0.9 (1.3%)	-21.6	< 0.001
Baseline social functioning	75.2 ± 14.1	74.8 ± 15.2	0.4	0.806
Postoperative social functioning at 3 months	60.3 ± 15.7	75.1 ± 14.8	-14.8	< 0.001
Change in social functioning	-14.9 (19.8%)	0.3 (0.4%)