Global prevalence of perioperative depressive symptoms among non-emergency surgical patients: An umbrella review of current evidence from systematic review and meta-analyses.

Abstract

Background: Evidence on perioperative depressive symptoms among non-emergency surgical patients is fragmented and inconsistent.

Objective: This umbrella review aims to systematically assess the strength and credibility of evidence on the worldwide prevalence of perioperative depressive symptoms among non-emergency surgical patients and investigate whether rates differ with pre-defined covariates.

Design: An umbrella review of current evidence from systematic reviews and meta-analyses.

Methods: We conducted an umbrella review of meta-analyses. Eight databases were searched until February 29, 2024, for systematic reviews and meta-analyses. Two independent reviewers conducted study selection, data extraction, and quality appraisal. The prevalence estimates were assessed for strength of evidence using umbrella review criteria and certainty of evidence using the Grading of Recommendations Assessment, Development, and Evaluation approach.

Results: This review included 11 meta-analyses, with 196 unique primary studies and 395,933 pre-surgical and 29,431 post-surgical patients. The methodological quality of the included reviews was predominantly critically low (10/11) based on standardised confidence ratings. The study- and meta-level analyses produced consistent findings. The study-level meta-analysis revealed notable reductions in depressive symptom prevalence post-surgery for specific subtypes, including spine surgery (34 % to 27 %), total joint replacement (23 % to 12 %), and hysterectomy (28 % to 18 %). Bariatric surgery had a pre-surgery prevalence rate of 24 %, while breast surgery and organ transplants demonstrated moderate post-surgery prevalence rates of 19 % and 24 %, respectively. Subgroup analyses indicated regional and measurement-specific differences, with East Asia and Oceania typically reporting higher prevalence rates than Europe and the Americas. All estimates showed high heterogeneity and were graded as suggestive evidence with low certainty per GRADE criteria.

Discussion: Depressive symptoms are common among non-emergency surgical patients and warrant clinical attention. However, prevalence estimates should be interpreted with caution due to high heterogeneity and a lack of data from low- and middle-income countries. Reviews remain limited for preoperative depressive symptoms in organ transplantation, breast surgery, and postoperative bariatric surgery. Integrating mental health screening and targeted interventions into perioperative care could improve outcomes. Future research should focus on standardised assessments and personalised mental health support for high-risk groups.

Registration: The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD42022342780). PROSPERO REGISTRATION NUMBER: (CRD42022342780).