Trauma-related, anxiety and depressive symptoms three months after hysterectomy for benign and malignant indications: An exploratory secondary analysis of two prospective cohorts

Objective To compare trauma-related, anxiety and depressive symptoms three months after hysterectomy for benign versus malignant indications and examine associations with surgical indication, age and preoperative psychotropic medication use. Methods This exploratory secondary analysis included 128 women from two prospective cohorts (100 benign, 28 malignant). The HADS was administered preoperatively, on postoperative day one and at three months; the PCL-5 on postoperative day one and at three months. Scores were recomputed from item responses. Binary outcomes were analysed using logistic and Firth models and continuous scores using HC3-robust linear regression. Results At three months, data were complete for 111 women (85 benign, 26 malignant). Preoperatively, 55 of 111 screened positive on the HADS-A (49.5%, 95% CI 40.4 to 58.7) and 13 of 108 on the HADS-D (12.0%, 95% CI 7.2 to 19.5). At three months, 34 of 111 screened positive on the HADS-A (30.6%, 95% CI 22.8 to 39.7), 28 of 111 on the HADS-D (25.2%, 95% CI 18.1 to 34.0), and 17 of 111 on the PCL-5 (15.3%, 95% CI 9.8 to 23.2). We found no evidence that surgical indication or psychotropic medication use was associated with any outcome. Conclusions HADS-A screening positivity was lower and HADS-D positivity higher at three months than preoperatively; 15.3% screened positive for trauma-related symptoms. Estimates comparing indications were imprecise and do not exclude clinically meaningful associations. Larger, contemporaneously recruited cohorts are needed.