Clinical trial supports adding mental health care to routine preparation for major surgery

by Washington University in St. Louis

edited by Gaby Clark, reviewed by Robert Egan

Gaby Clark

Scientific Editor

Meet our editorial team
Behind our editorial process

Robert Egan

Senior Editor

Meet our editorial team
Behind our editorial process Editors' notes

This article has been reviewed according to Science X's editorial process and policies. Editors have highlighted the following attributes while ensuring the content's credibility:

fact-checked

peer-reviewed publication

trusted source

proofread

The GIST Add as preferred source

Facing major surgery is stressful, but for older adults, unaddressed anxiety and depression can impede physical recovery. A clinical trial led by researchers at Washington University School of Medicine in St. Louis found that starting an intervention before surgery—one that combines mental health coaching with optimization of medications that may increase risks for older adults—reduces postsurgery anxiety and depression.

"The time around surgery is a window of both risk and opportunity," said the study's first author Joanna Abraham, Ph.D., a professor in the Department of Anesthesiology at WashU Medicine. "The stress of surgery can worsen anxiety and depression symptoms and affect patients' recovery and overall health, but it also offers a critical opportunity to identify these concerns proactively and connect patients with the support they need."

The study, published Sept. 9 in JAMA Network Open, supports including mental health care and medication optimization in routine presurgical care.

"We recognize the importance of getting the body into shape before surgery, but preparing the mind and the brain is just as important," said the study's senior author Eric J. Lenze, MD, the Wallace and Lucille K. Renard Professor of Psychiatry and head of the WashU Medicine Department of Psychiatry. "Patients undergoing major surgery hope for a better life afterward, and our study shows that taking care of emotional well-being and optimizing medications can help deliver that outcome."

Addressing emotional distress, high-risk medications

Up to 33% of older surgical patients in the U.S. experience depression, and 22% experience anxiety before surgery. In addition, older patients frequently take multiple drugs that affect the brain, including sedatives, muscle relaxants and over-the-counter sleep aids. Without routine reevaluation for safety or necessity, these prescriptions can accumulate and increase risks such as sedation, confusion and falls. High-risk medications also can raise an older patient's odds of postsurgery confusion, dangerous falls and long-term physical pain.

Traditional perioperative care—the care patients receive before, during and after surgery—focuses on physical healing, often leaving emotional distress untreated, Lenze explained. To close this gap, the researchers designed and tested a practical care model for older adults facing surgery. They conducted the clinical trial through WashU Medicine's Center for Perioperative Mental Health, whose mission is to integrate holistic mental health care and medication optimization into routine surgical medicine.

The study analyzed 306 adults ages 60 and older who were scheduled for cardiac, oncologic or orthopedic surgery at hospitals across the BJC HealthCare system. Screened patients who reported mild to moderate symptoms of depression and anxiety were enrolled in the study.

The patients were randomly assigned to one of two groups. In addition to receiving educational materials on mindfulness, sleep and brain health, the intervention group talked with a dedicated wellness coach—a trained mental health professional such as a social worker or mental health counselor—over eight to 12 phone sessions. They also received a personalized review by pharmacists and doctors to safely optimize doses of high-risk medications. The control group received only the self-help materials to read independently, the standard approach to presurgical care.

The researchers found that three months after surgery, patients receiving the intervention experienced a 2.2- to 2.5-point greater reduction in symptoms of depression and anxiety than patients given educational materials alone, using a 48-point scale. Older adults undergoing cancer surgery experienced the strongest mental health improvements, scoring nearly 5 points lower than the control group.

Furthermore, patients reported positive experiences with the extra care, both from the wellness providers and the pharmacists who worked to eliminate unnecessary medications.

"What makes this care model so promising is that it's practical to deliver," said Abraham. "Patients and health care providers found the program manageable and easy to integrate into existing surgical workflows. Proactive mental health care doesn't have to burden the hospital system."

However, making that shift requires clinical specialties to break out of traditional silos to coordinate care before surgery.

"Today's perioperative care models do not adequately address mental health needs and challenges faced by older adults," added Avidan, the Dr. Seymour and Rose T. Brown Professor of Anesthesiology, who serves as the center's co-director with Lenze. "The results of this trial suggest that anesthesiology and psychiatry can unite to treat surgical patients more holistically, pioneering a practical blueprint that hospital systems nationwide can use to improve recovery after invasive procedures."

Publication details

Perioperative depression and anxiety care in older patients: a randomized clinical trial., JAMA Network Open (2026). DOI: 10.1001/jamanetworkopen.2026.32619

Journal information: JAMA Network Open

Clinical categories

Psychology & Mental healthPsychiatryAnesthesiologyHealthy aging Provided by Washington University in St. Louis Who's behind this story?

Gaby Clark

MA in English, copy editor since 2021 with experience in higher education and health content. Dedicated to trustworthy science news. Full profile →

Robert Egan

Bachelor's in mathematical biology, Master's in creative writing. Well-traveled with unique perspectives on science and language. Full profile →

Citation: Clinical trial supports adding mental health care to routine preparation for major surgery (2026, September 9) retrieved 9 September 2026 from https://medicalxpress.com/news/2026-09-clinical-trial-adding-mental-health.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.