• Robert B Schonberger, Jessica Feinleib, Natalie Holt, Feng Dai, Cynthia Brandt, and Matthew M Burg.
• Department of Anesthesiology, Yale University School of Medicine, New Haven, CT. Electronic address: robert.schonberger@yale.edu.
• J. Cardiothorac. Vasc. Anesth. 2014 Dec 1; 28 (6): 1467-73.

ObjectivesTo test the association among depression symptoms, distressed personality type, and preoperative beta-blocker nonadherence and to estimate the prevalence of untreated major depression in this population.DesignProspective observational study.SettingA veterans hospital.ParticipantsOne hundred twenty patients on outpatient beta-blocker therapy presenting for surgery.InterventionsThe Patient Health Questionnaire (PHQ)-9, the D-Scale-14 (DS14), and Modified Morisky Scale (MMS) questionnaires.Measurements And Main ResultsOf 99 participants who presented for surgery, the incidence of preoperative nonadherence was 14.1% (95% confidence interval 7%-21%), consistent with prior research. Nonadherence was 9.5% among those with no depression, 27.8% among those with mild depression, and 28.6% among those with moderate-to-severe depression (Cochran-Armitage test for trend p = 0.03). Distressed personality type was found in 35% of the cohort (95% confidence interval 26-45%) and was not associated with beta-blocker nonadherence (Fisher's exact test, p = 0.24). Among participants with symptoms of major depressive disorder (n = 25, 25.3%), more than half (n = 14, 56%) had no indication of depression listed at their most recent primary care visit.ConclusionsPatients with symptoms of depression on chronic beta-blocker therapy are susceptible to medication nonadherence on the day of surgery. Most surgical patients with symptoms of major depression lack a diagnosis of depression. Preoperative depression screening may thus (1) identify a population at increased risk of beta-blocker withdrawal, and (2) identify patients who may benefit from anesthesiologist-initiated referral for this treatable condition.Copyright © 2014 Elsevier Inc. All rights reserved.

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