Post-Traumatic Stress Disorder, Anxiety, and Depression in Patients after Undergoing Cesarean Hysterectomy for Placenta Accreta Spectrum Disorder.

OBJECTIVE

Medically complicated pregnancies and deliveries can lead to adverse mental health outcomes, including post-traumatic stress disorder (PTSD). However, few studies have examined mental health outcomes after surgery for placenta accreta spectrum (PAS). Our aim was to identify prevalence of PTSD, anxiety, and depression in patients who underwent hysterectomy for PAS. We sought to understand whether more complex or emergent surgery was associated with a higher prevalence of PTSD and whether physical symptoms such as pelvic pain were correlated with patients' mental health outcomes.

STUDY

DESIGN

This was a cross-sectional study of patients who underwent a cesarean hysterectomy for PAS between January 2018 and August 2023 at a single urban hospital. Patients were recruited 6 months or more following surgery. The survey consisted of validated questionnaires (National Stressful Events Survey short scale for symptoms of PTSD, General Anxiety Disorder, and Patient Health Questionnaire) and clinical data were abstracted from the medical record.

RESULTS

During the study period, 100 patients underwent a hysterectomy for PAS, of which 61 completed the survey. Patients most frequently screened positive for PTSD (n/N = 13/61, 21.3%), followed by anxiety (n/N = 10/61, 16.4%) and depression (n/N = 8/61, 13.1%). The prevalence of anxiety and depression was similar to the patients' self-reported diagnosis prior to surgery. The prevalence of PTSD was not affected by severe maternal morbidity or urgency of the surgical case. However, pelvic floor symptoms, specifically urge incontinence, were associated with PTSD, anxiety, and depression.

CONCLUSION

In patients who undergo cesarean hysterectomy for PAS, nearly a quarter may experience PTSD symptoms, higher than the general postpartum population. Given the high prevalence of symptoms and the lack of specific patient risk factors associated with PTSD, all patients with PAS should be offered mental health services before and after delivery.

KEY POINTS: · Patients who undergo hysterectomy for PAS experience high prevalence of PTSD.. · Emergent surgery and severe morbidity are not associated with postpartum PTSD, anxiety, or depression.. · Adverse mental health outcomes are associated with pelvic floor symptoms, such as incontinence..