Association of preoperative anxiety and depression with quality of recovery after caesarean delivery: a prospective observational study.

Introduction: To investigate the association between the presence of both anxiety and depression and the quality of recovery after caesarean delivery.

Methods: This secondary analysis of a prospective observational study included 137 patients aged ≥ 18 years who underwent elective and urgent caesarean delivery under spinal anesthesia and completed the Obstetric Quality of Recovery-11 scale at least once postoperatively. Before caesarean delivery, patients were screened for anxiety and depression using the Hospital Anxiety and Depression Scale. A total score of ≥ 8 in each subscale was considered positive screening. Postpartum quality of recovery was assessed using the Obstetric Quality of Recovery-11 at three time points, with a higher score indicating better recovery.

Results: Among the eligible patients, 17.5% (24/137) screened positive for both anxiety and depression. No significant difference was found in the Obstetric Quality of Recovery-11 score 24 h after caesarean delivery (p = 0.13, Cohen's d = 0.33), but differences were observed on postoperative day 3 (p = 0.004, Cohen's d = 0.67) and postoperative day 5 (p = 0.01, Cohen's d = 0.58). In the multiple regression analysis, after adjusting for prominent clinical factors, the presence of both anxiety and depression was associated with the Obstetric Quality of Recovery-11 score on postoperative day 3 (p = 0.01) and postoperative day 5 (p = 0.01), but not 24 h after delivery (p = 0.19).

Conclusions: Positive Hospital Anxiety and Depression Scale screening for both anxiety and depression was associated with a poor quality of recovery, measured using the Obstetric Quality of Recovery-11 scores on PODs 3 and 5.