The impact of pain and depression on recovery after coronary artery bypass grafting

Abstract

Objective: To describe the relationship between pain and depression on recovery after coronary artery bypass grafting (CABG).

Methods: A secondary data analysis on 453 depressed and nondepressed post-CABG patients enrolled in a randomized, controlled, effectiveness trial of telephone-delivered collaborative care for depression. Outcome measures were collected from March 2004 to September 2007 and included pain, physical function, and mood symptoms.

Results: Depressed patients (baseline Patient Health Questionnaire-9 score ≥10) versus those without depression reported significantly worse pain scores on the 36-Item Short Form Health Survey Bodily Pain Scale at baseline and up to 12 months post-CABG, p < .05. Among patients with depression, those who received collaborative care reported significantly better pain scores at each time point between 2 and 12 months post-CABG versus depressed patients randomized to the usual care control group, p < .05. Regardless of intervention status, depressed participants with at least moderate pain at baseline reported significantly lower functional status (measured by the Duke Activity Status Index) at 8 and 12 months versus depressed patients with none or mild pain, p < .05. Depressed patients with at least moderate pain at baseline were also significantly less likely to show improvement of depressive symptoms throughout the course of follow-up versus depressed patients with little or no pain, p < .05. These findings controlled for age, gender, education, race, comorbid conditions, and baseline pain diagnosis.

Conclusions: Depression and pain seem to influence functional recovery post-CABG. The relationship between these two conditions and 12-month outcomes should be considered by clinicians when planning treatment.

Figures

Figure 1

Course of pain symptoms post-CABG among depressed and nondepressed patients. Higher score less pain. *Nondepressed vs. depressed (includes both intervention and usual care groups), P<0.05 **Depressed/intervention vs. depressed/usual care, P <0.05. INT: Depressed/intervention; UC: Depressed/usual care; ND: Nondepressed; CABG: Coronary artery bypass graft.

Figure 2

Course of functional status post-CABG among depressed patients assigned to collaborative care intervention group or usual care group by pain level. Higher score is better. P <0.05 at 8 and 12 months for: INT/moderate pain + UC/moderate pain vs. INT/none or mild pain + UC/none or mild pain. P =0.04 at 12 months for: INT/moderate pain + INT/none or mild pain vs. UC/moderate pain + UC/none or mild pain. INT: Depressed/intervention; UC: Depressed/usual care; CABG: Coronary artery bypass graft. The sample size (N) at each timepoint reflects the mean of those who completed the assessment for that timepoint.

Figure 3

Course of depression symptoms post-CABG among depressed patients assigned to the collaborative care intervention group or usual care group by pain level. Lower score is better. P <0.05 at every time point for: INT/moderate pain + UC/moderate pain vs. INT/none or mild pain + UC/none or mild pain. P =0.02 at 12 months for: INT/moderate pain + INT/none or mild pain vs. UC/moderate pain + UC/none or mild pain. INT: Depressed/intervention; UC: Depressed/usual care; CABG: Coronary artery bypass graft. The value of the Hamilton Rating Scale-Depression score at each timepoint reflects the mean of those who completed the assessment for that timepoint.