Depression, Anxiety Disorders and Type D Personality as Risk Factors for Delirium After Cardiac Surgery

• Published in: Australian and New Zealand journal of psychiatry 2010-11, Vol.44 (11), p.1005-1011
• Main Authors: Tully, Phillip J., Baker, Robert A., Winefield, Helen R., Turnbull, Deborah A.
• Format: Article
• Language: English
• Subjects: Adult and adolescent clinical studies; Aged; Anxiety Disorders - complications; Anxiety Disorders - psychology; Anxiety disorders. Neuroses; Biological and medical sciences; Cardiac Surgical Procedures - adverse effects; Cardiac Surgical Procedures - psychology; Confidence Intervals; Delirium - etiology; Delirium - psychology; Depression; Depressive Disorder - complications; Depressive Disorder - psychology; Depressive Disorder, Major - complications; Depressive Disorder, Major - psychology; Female; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - psychology; Humans; Male; Medical sciences; Middle Aged; Mood disorders; Myocardial Revascularization - adverse effects; Myocardial Revascularization - psychology; Odds Ratio; Organic mental disorders. Neuropsychology; Panic disorder; Panic Disorder - complications; Panic Disorder - psychology; Personality; Personality Inventory; Psychiatric Status Rating Scales; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotropic Drugs - adverse effects; Psychotropic Drugs - therapeutic use; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart
• ISSN: 0004-8674; 1440-1614
• DOI: 10.3109/00048674.2010.495053

Objectives: To determine the prognostic risk of incident delirium after cardiac surgery attributable to preoperative affective disorders and Type D personality. Methods: Patients awaiting elective coronary revascularization surgery (N = 158; 20.9% female; 11.4% concomitant valve surgery; age M = 64.7, SD = 10.6) underwent the structured MINI International Neuropsychiatric Interview and completed a measure of Type D personality. Postoperative incident delirium was established prior to discharge from the index hospitalization with structured psychiatric interview. Results: The prevalence of psychiatric disorders before cardiac surgery was 17.1% for major depression, 7.6% for panic disorder, 10.1% for generalized anxiety disorder, and 13.3% for Type D personality, while there were 49 (31% of total) cases of delirium after surgery. After adjustment for sex, older age, cross-clamp time, haemoglobin (Hb) and psychotropic drug use, major depression was significantly associated with delirium, odds ratio (OR) = 3.86 (95% confidence interval (CI) 1.42 to 10.52, p = 0.001). Adjustment for clinical covariates suggested that Type D personality was not significantly associated with delirium, OR = 2.85 (95%CI 0.97 to 8.38, p = 0.06). Conclusions: Major depression was significantly associated with incident delirium after cardiac surgery. These findings suggest that the risk of incident delirium attributable to major depression was not merely a reflection of common diagnostic features in prospectively examined cardiac surgery patients.