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 pre- operatively; 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.