The interrelated associations of social relationship factors, depression, and outcomes of surgical patients are yet unexplored. The purpose of this study was to investigate whether depression mediates effects of general social support, loneliness, and living alone on hospital length of stay (LOS) of 2487 patients from diverse surgical fields.
Social relationship factors and depression were assessed prior to surgery. The PROCESS macro for SPSS was used to conduct three simple mediation models that tested the indirect effects of social relationship factors on LOS mediated through depression. The models were adjusted for age, gender, preoperative physical health, surgical field, severity of medical comorbidity, and extent of surgical procedure.
Social support and loneliness had significant indirect effects on LOS that were statistically mediated by preoperative depression. Lower social support and the feeling of loneliness were considerably related to higher depression which predicted longer LOS. While social support and loneliness had no direct effects on LOS, there was a small significant direct association of living alone with shorter LOS.
Data suggest that social support and loneliness are indirectly related with surgical outcomes by an association with depression which in turn is related to worse outcomes.
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The authors wish to thank the teams of the preoperative anesthesiological assessment clinics and of BRIA (Bridging Intervention in Anesthesiology), Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, for the excellent help with patient care, data collection, and analysis.
This study was supported by the DFG (German Research Foundation, Bonn, Germany; Grant KR 3836/3-1). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Conflicts of Interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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Krampe, H., Barth-Zoubairi, A., Schnell, T. et al. Social Relationship Factors, Preoperative Depression, and Hospital Length of Stay in Surgical Patients. Int.J. Behav. Med. 25, 658–668 (2018). https://doi.org/10.1007/s12529-018-9738-8
- Length of hospital stay
- Mediation analysis
- Social support