Mental health sequelae in the perioperative period: An examination of perioperative dissociation, postoperative delirium, and posttraumatic stress
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Date
2019
Authors
Sommer, Jordana
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Abstract
Perioperative dissociation and postoperative delirium are adverse mental health outcomes that can occur in the context of surgery and are both independently associated with posttraumatic stress (PTS). Using quantitative and qualitative methodologies across two studies, this thesis aimed to identify whether symptom overlap exists between perioperative dissociation and postoperative delirium, examine how perioperative dissociation and postoperative delirium are associated with PTS (study 1; quantitative), understand how individuals describe and experience symptoms of dissociation and delirium, and examine the impact of these symptoms on the recovery process (study 2; qualitative). Both studies included a sub-sample of non-emergent surgical patients (study 1: n = 181; study 2: n = 5), aged 60 years and older, who participated in the Electroencephalography Guidance of Anesthesia to Alleviate Geriatric Syndromes (ENGAGES-CANADA; N = 492 at time of analysis) study. In study 1, a principal components analysis did not support symptom overlap between dissociation and delirium and multiple linear regressions revealed both symptom presentations were associated with PTS; however, differential relationships emerged according to the covariates included. Using qualitative methods informed by constructivist grounded theory, study 2 revealed a main theme of silence of perioperative mental health; participants did not describe or elaborate on perioperative mental health experiences when asked, and focused on their physical health-related experiences. Findings of these two studies highlight important similarities and differences between dissociation and delirium. In addition, results underscore the importance of communication, assessment, and monitoring of these symptoms, which may help reduce adverse perioperative mental health outcomes.
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Keywords
Perioperative dissociation, Postoperative delirium, Posttraumatic stress, Surgery