Perioperative Care Reduced Depression and Anxiety Symptoms

A perioperative intervention combining psychological management and medication optimization produced a greater reduction in depression and anxiety symptoms 3 months after surgery than enhanced usual care among older adults. Findings from the randomized clinical trial were published in JAMA Network Open.

The single-blind, hybrid type 1 effectiveness-implementation trial enrolled adults aged 60 years or older with clinically meaningful symptoms who were scheduled for cardiac, oncologic, or orthopedic surgery in one US academic and community practice hospital network. Of 326 randomized participants, 20 were excluded after surgery cancellation, leaving 306 in the modified intention-to-treat analysis, with 153 in each group. The trial is registered with the following ClinicalTrials.gov identifiers: (NCT05575128, NCT05685511, and NCT05697835). 

The intervention paired structured psychological management from master’s-level social workers or counselors with medication optimization led by a pharmacist team under geriatric psychiatrist oversight. Controls received written symptom self-management materials. The primary outcome was change in the Patient Health Questionnaire–Anxiety and Depressive Symptom (PHQ-ADS) score from baseline to 3 months after surgery.

At 3 months, the pooled between-group difference in PHQ-ADS improvement favored the intervention by 2.20 points (95% CI, 0.16-4.24; P=0.03). Effects varied across cohorts: 4.93 points for oncologic patients (95% CI, 1.51-8.36; P=0.005), 2.68 points for cardiac patients (95% CI, −0.98 to 6.35; P=0.15), and −1.11 points for orthopedic patients (95% CI, −4.62 to 2.40; P=0.54).

Exploratory findings favored the intervention for persistent postsurgical pain and several pain measures at 1 month, but not at 3 months. Length of stay, delirium, rehospitalization, falls, and health-related quality of life did not significantly improve. No trial-related adverse events occurred. Limitations included the single-system setting, lack of an attention-matched control, exclusion of non-English speakers and patients with active suicidal ideation or moderate-to-severe cognitive impairment, a predominantly non-Hispanic White population, and limited power for exploratory outcomes. Investigators said larger studies are needed to confirm the findings and determine which patients benefit most.

Source: Abraham J, Holzer KJ, Haroutounian S, et al. Perioperative depression and anxiety care in older patients: a randomized clinical trial. JAMA Netw Open. 2026;9(9):e2632619. doi:10.1001/jamanetworkopen.2026.32619