Abstract The focus of this paper is to conclude a theory that presents an explanation as to why a large percentage of patients often develop depression post open-heart surgery. This theory will consider dynamic causes of depression including physiological, psychological, developmental, social, and spiritual factors of patient experiences. Post-Cardiovascular Surgery Depress Physiologic Stressors Depression is among one of the many risks involving any cardiac open-heart surgical procedure.
The body is put under a tremendous amount of physical stress and could cause someone to feel the effects of depression. A saw is used to crack open the sternum, the muscles are stretched apart and the adjacent nerves are strained to expose the underlying body systems. The combination of broken bones, pulled muscles, and pinched nerves can cause extreme pain in the patient. The pain experienced by this procedure can deter patients from taking the necessary steps to rehabilitate themselves and from returning to their optimum state of wellness.
The physical pain could prevent one from working with physical therapy, causing further muscle and mobility loss. The simple task of taking a deep breath may be far too painful for patients and potentially cause further problems such pneumonia. Patients are told after surgery their length of stay is four to five days so long as there are no complications. If patients are unable to return to their normal level of functioning they potentially would have to go to inpatient rehab, assisted living facilities or their length of stay may be increased before able to return home.
Other common post operative complications such as dysrhythmias cause a patient’s length of stay in the hospital to be greater than anticipated which also contributes to their depressed mental state. Psychological Stressors Sometimes the greatest conflict a patient endures post open-heart surgery is the struggle between his or her own psyche and mentality. Pain, although may seem like a physical stressor actually can cause an adverse effect on a patient’s dignity and may shatter his or her confidence.
Simple tasks such as taking deep breathing and preforming their minimum of four walks daily may cause the patient to view those tasks as impossible feats due to their pain and lack of confidence. An added stressor one may find difficult to accept is his or her altered body image. Open-heart surgeries leave a fairly large and noticeable mid-sternal incision and may cause the patient to become depressed about the change to their physical appearance. Developmental Stressors
It is proven fact that post cardiothoracic surgical procedures cause a decline in cognitive function in patients that is potentially irreversible but in most causes resolves with in a few months after surgery (Fintel, 2011). This cognitive delay can cause unclear thinking and reasoning in patients preventing them from reaching reconstitution. The cognitive delay may present as frustration in patients but ultimately results in depression. Social Stressors
Patients experience mental and physical stressors from open-heart surgery but also experience extra-personal stressors that are placed on their social life. Since patients are unable to drive, use their upper body for any type of strenuous activity, or lift anything greater than 5lbs for six to eight weeks post open-heart surgery, it is possible that the activity restrictions post-op put a damper on one’s spirit because he or she is unable to preform their usual activities needed for everyday life, fitness, work, etc.
This causes patients to often feel that their independence is taken away and feel frustration for having to depend on others to do things for them, and an overwhelming sense of guilt for having to place their burden on others close to them, which are all factors that further contribute to his or her depressive state of mind. Patients often feel guilty and realize that their numerous amount of needs and support put a strain on others close to them, whether it is another family member or friend.
Patient’s worry that the relationships they had pre-open heart surgery will never be the same due to their condition. It is important for patients to realize that a support system is so vital to their recovery and wellbeing. Spiritual Stressors Open-heart surgery will also try a patient’s spirituality. Patients may ask God, “why me? ” and develop a sense of anger and or betrayal. This may cause he or she to feel forsaken and separated from God; this mistrust in God can further contribute to a patient’s loneliness and depression.
The varying combinations of stressors mentioned above compromise a patients normal state of mind and can easily be attributed to their negative and depressed way of thinking which only makes sense to lash out against God. Hopefully a patient’s actions and mentality can be persuaded and enlightened by the nurse or others taking care of the patient. (Isaiah 41:10 KJV) “Don’t you be afraid, for I am with you. Don’t be dismayed, for I am your God. I will strengthen you. Yes, I will help you.
Yes, I will uphold you with the right hand of my righteousness. ” It is important for the patients to see their condition in a more positive and proactive light. This patient should view their surgery as a success through the power of God and as second chance to change their life style to improve their health and hopefully prevent the need for future surgical procedures. Conclusion The author speculates that post open-heart surgery depression is triggered by an array of stressors.
The diverse stressors discussed above act in conjunction and almost create domino effect to cause a patient to feel overcome with depression. The physiological stressors trigger patients to become hopeless about their physical restrictions and cognitive dysfunction, which leads to self doubt, dependence on others which affects their psyche. The preceding psychological stress causes them to rely on family and friends for support and depression can stem from lack of support received or from guilt; which causes them to become reclusive to their former social domain.
Finally when patients are feeling low and alone he or she may choose to blame God for their current predicament. There are many directions in which stressors can develop to cause depression in patients but the writer believes that it is the integration of all these stressors that further contribute to ones depressed state of mind. Discussion Question Do you think there are other causes of post open-heart surgery depression that I did not mention? If so, what else could help explain the cause? Do you support my theory?