Trajectories and risk factors of depressive symptomatology following hysterectomy

Andrew S. Bossick, Wan‐Ting Su, J Abood, Victoria Arruga Novoa y Novoa, Petra Chamseddine, Annmarie Vilkins, Ganesa Wegienka
In: Menopause · 2025 · vol. 32(11) , pp. 1014–1021 · doi:10.1097/gme.0000000000002606 · PMID:40794489 · W4413114174
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⚙ AI-generated summary by claude@2026-06, 2026-06-09 ⓘ

This study identified three depressive symptom trajectories after hysterectomy, finding that insurance type, financial toxicity, pain, and surgical satisfaction were associated with higher symptom levels.

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⚙ AI-generated deep summary by claude@2026-06, 2026-06-09 · read from full text ⓘ

This study investigated trajectories and risk factors of depressive symptomatology after hysterectomy for benign causes, using repeated Patient Health Questionnaire-9 (PHQ-9) assessments collected before surgery and at multiple postoperative time points (2 weeks, 1/4/6 weeks, and 3/6/12 months) in 455 participants scheduled for hysterectomy without concomitant urogynecological procedures. Latent class analysis identified three depressive symptom trajectories: high and increasing, high and decreasing, and persistently low, and multivariable multinomial logistic regression estimated how baseline sociodemographic, clinical, and operative-related factors related to class membership. Insurance type, financial toxicity, pain level, and surgical decision satisfaction before surgery were significantly associated with trajectory membership, with higher pain and worse finances characterizing groups with elevated depressive symptoms. This paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

OBJECTIVES: Hysterectomy is the second most common gynecological surgery performed on reproductive aged women in the United States. It is not known if some groups of women are more susceptible to depression after hysterectomy. METHODS: Participants were scheduled for hysterectomy for benign causes and not undergoing a concomitant urogynecological procedure. Patient Health Questionnaire-9 (PHQ-9) was collected 2 weeks before, and 1, 4, and 6 weeks, and 3, 6, and 12 months post-hysterectomy to understand depressive symptoms associated with surgery. PHQ-9 patterns were identified with latent class analyses. Multivariable multinomial logistic regression was used to estimate relative risk ratios (RRR) and 95% CIs of associations between baseline sociodemographic, clinical, and operative-related characteristics and PHQ-9 class. RESULTS: Three latent classes (C) were identified from their PHQ-9 score patterns among 455 participants: high and increasing (C1, 15.6%), high and decreasing (C2, 27.7%), and persistently low PHQ-9 trajectory (C3, 56.7%). Insurance type, financial toxicity, pain level, and surgical decision satisfaction before surgery were statistically significantly associated with class membership. At surgery, C1 members were more likely to have public insurance (RRR=2.04, CI: 1.02-4.08), worse finances (0.92, 0.89-0.96), and higher pain (1.22, 1.10-1.35) than members of C3. C2 members were more likely to have worse finances (0.94, 0.91-0.96) than C3 members. C1 members tended to have higher pain (1.14, 1.02-1.26) than C2 members. CONCLUSIONS: Depression symptomology after hysterectomy may be associated with presurgical insurance type, financial toxicity, current pain level, and satisfaction. More research is needed to investigate whether these factors can be incorporated into preoperative counseling and screening tools to guide shared decision-making regarding depression and surgery.
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Objectives

Hysterectomy is the second most common gynecological surgery performed on reproductive aged women in the United States. It is not known if some groups of women are more susceptible to depression after hysterectomy.

Methods

Participants were scheduled for hysterectomy for benign causes and not undergoing a concomitant urogynecological procedure. Patient Health Questionnaire-9 (PHQ-9) was collected 2 weeks before, and 1, 4, and 6 weeks, and 3, 6, and 12 months post-hysterectomy to understand depressive symptoms associated with surgery. PHQ-9 patterns were identified with latent class analyses. Multivariable multinomial logistic regression was used to estimate relative risk ratios (RRR) and 95% CIs of associations between baseline sociodemographic, clinical, and operative-related characteristics and PHQ-9 class.

Results

Three latent classes (C) were identified from their PHQ-9 score patterns among 455 participants: high and increasing (C1, 15.6%), high and decreasing (C2, 27.7%), and persistently low PHQ-9 trajectory (C3, 56.7%). Insurance type, financial toxicity, pain level, and surgical decision satisfaction before surgery were statistically significantly associated with class membership. At surgery, C1 members were more likely to have public insurance (RRR=2.04, CI: 1.02-4.08), worse finances (0.92, 0.89-0.96), and higher pain (1.22, 1.10-1.35) than members of C3. C2 members were more likely to have worse finances (0.94, 0.91-0.96) than C3 members. C1 members tended to have higher pain (1.14, 1.02-1.26) than C2 members.

Conclusions

Depression symptomology after hysterectomy may be associated with presurgical insurance type, financial toxicity, current pain level, and satisfaction. More research is needed to investigate whether these factors can be incorporated into preoperative counseling and screening tools to guide shared decision-making regarding depression and surgery.

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