Factors of preoperative anxiety in primary school-aged children with orthopedic pathology undergoing surgical treatment

   Relevance. The situation of surgical treatment has a high stress potential contributing to the development of preoperative anxiety, which is a risk factor for adverse psychological states in the postoperative period.

   Purpose: to determine the psychological content and factors influencing the risk of developing preoperative anxiety in children of primary school age.

   Methodology. The study examined 20 mothers and 20 children (10 boys, 10 girls) aged 8 to 10 years with orthopedic pathology. Each examination was conducted on the 2nd–3rd day after hospitalization, 3–5 days before the anticipated surgical intervention. Psychological assessment of the child included observation aimed at assessing the severity of signs of anxiety; structured interview; questionnaire “Children’s Manifest Anxiety Scale” (CMAS), Visual Analogue Pain Scale. Psychological examination of the mother included a survey, “Assessment of the child’s anxiety level” (A.I. Zakharov); “Diagnostics of attitude towards a child’s illness”; “State Trait Anxiety Inventory” (STAI).

   Results and Discussion. 80 % of children showed behavioral signs of anxiety (tension, withdrawal, avoidance of contact, restlessness, repeated actions, tearfulness). Adaptation to hospital conditions is accompanied by sleep disturbances (40%) and loss of appetite (60 %). The average values on the CMAS questionnaire correspond to the borderline level (6.6 ± 0.52). Based on observation and survey, a subgroup (5 boys, 4 girls) with a high level of preoperative anxiety was identified. There were no significant differences in children with a high level of preoperative anxiety by gender, age, family status, presence/absence of siblings, age and education of the mother, experience of surgical treatment, duration of the disease, level of pain symptoms, or knowledge about treatment. At the same time, children with a high level of preoperative anxiety had increased personal anxiety (p = 0.03), more often mentioned the possibility of medical errors as a source of fear, and their mothers had a higher level of situational anxiety (STAI, p = 0.01) and increased tendency to control the child’s activity (p = 0.04).

   Conclusion. Severe preoperative anxiety is observed in almost half of children awaiting surgical treatment. The risk factor for preoperative anxiety is the child’s personal anxiety, as well as the mother’s situational anxiety and her tendency to limit the child’s activity.

1. Dubinina E.A., Alekhin A.N. Psihologicheskie reakcii detej na situaciju hirurgicheskogo lechenija: obzor issledovanij [Psychological reactions of children to the situation of surgical treatment : a review of studies]. Klinicheskaya i spetsial’naya psikhologiya [Clinical psychology and special education]. 2023; 12(4): 5–26. URL: https://psyjournals.ru/journals/cpse/archive/2023_n4/Dubinina_Alekhin. DOI: 10.17759/cpse.2023120401 (In Russ.)

2. Zaharov A.I. Proishozhdenie detskih nevrozov i psihoterapija. [The origin of childhood neurosis]. Moscow, 2000. 448 p. (In Russ.)

3. Kagan V.E., Zhuravleva I.P. Metodika diagnostiki otnoshenija k bolezni rebenka (DOBR) [A method for diagnosing attitudes towards a child’s illness (DOBR)]. Psihodiagnosticheskie metody v pediatrii i detskoj psihonevrologii [Psychodiagnostic methods in pediatrics and child psychoneurology]. Sankt-Peterburg, 1991. Pp. 30–34. (In Russ.)

4. Prihozhan A.M. Trevozhnost’ u detej i podrostkov: psihologicheskaja priroda i vozrastnaja dinamika. [Anxiety in children and adolescents: psychological nature and age dynamics]. Moscow – Voronezh, 2000. 304 p. (In Russ.)

5. Hanin Ju.L. Kratkoe rukovodstvo k shkale reaktivnoj i lichnostnoj trevozhnosti Ch.D. Spilbergera [A quick guide to the reactive and trait anxiety scale of Ch.D. Spielberger]. Leningrad, 1976. 18 p. (In Russ.)

6. Ayenew N.T., Endalew N.S., Agegnehu A.F., Bizuneh Y.B. Prevalence and factors associated with preoperative parental anxiety among parents of children undergoing anesthesia and surgery: A cross-sectional study. Int. J. Surg. Open. 2020; 24: 18–26. DOI: 10.1016/j.ijso.2020.03.004

7. Chieng Y.J., Chan W.C., Klainin-Yobas P., He H.G. Perioperative anxiety and postoperative pain in children and adolescents undergoing elective surgical procedures : a quantitative systematic review. J Adv Nurs. 2014; 70(2): 243–255. DOI: 10.1111/jan.12205

8. Chow C., Rizwan A., Poulin L. [et al.]. Association of temperament with preoperative anxiety in pediatric patients undergoing surgery : A systematic review and meta-analysis. JAMA Network Open. 2019; 2(6). R. e195614. DOI: 10.1001/jamanetworkopen.2019.5614

9. Davidson A.J., Shrivastava P.P., Jamsen K. [et al.]. Risk factors for anxiety at induction of anesthesia in children a prospective cohort study. Pediatr Anesth. 2006; 16: 919–927. DOI: 10.1111/j.1460-9592.2006.01904.x

10. Friedrich S, Reis S, Meybohm P, Kranke P. Preoperative anxiety. Curr Opin Anaesthesiol. 2022; 35(6): 674–678. DOI: 10.1097/ACO.0000000000001186

11. Gélinas C., Puntillo K.A., Levin P., Azoulay E. The Behavior Pain Assessment Tool for critically ill adults: A validation study in 28 countries. Pain. 2017; 158: 811–821. DOI: 10.1097/j.pain.0000000000000834

12. Getahun A.B., Endalew N.S., Mersha A.T., Admass B.A. Magnitude and Factors Associated with Preoperative Anxiety Among Pediatric Patients: Cross-Sectional Study. Pediatric Health Med Ther. 2020; 11: 485–494. DOI: 10.2147/PHMT.S288077

13. Kain Z.N., Caldwell-Andrews A.A., Maranets I. [et al.]. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors. Anesth Analg. 2004; 99(6): 1648–1654. DOI: 10.1213/01.ANE.0000136471.36680.97

14. Kain Z.N., Mayes L.C., O’Connor T.Z., Cicchetti D.V. Preoperative anxiety in children Predictors and outcomes. Arch Pediatr Adolesc Med. 1996; 150(12): 1238–1245. DOI: 10.1001/archpedi.1996.02170370016002

15. Kain Z.N., Mayes L.C., Weisman S.J., Hofstadter M.B. Social adaptability, cognitive abilities, and other predictors for children’s reactions to surgery. J Clin Anesth. 2000; 12(7): 549–554. DOI: 10.1016/s0952-8180(00)00214-2

16. Kar S.K., Ganguly T., DasGupta C.S., Goswami A. Preoperative Anxiety in pediatric population: Anesthesiologists nightmare. Translational biomedicine. 2015. 6(4): 30. DOI: 10.21767/2172-0479.100030

17. Karling M, Stenlund H, Hägglöf B. Child behaviour after anaesthesia: associated riskfactors. Acta Paediatr. 2007; 96(5): 740–747. DOI: 10.1111/j.1651-2227.2007.00258.x

18. Liu W., Xu R., Jia J. [et al.] Research progress on risk factors of preoperative anxiety in children : A scoping review. International journal of environmental research and public health. 2022; 19(16): 9828. DOI: 10.3390/ijerph19169828

19. Rabbitts J.A., Groenewald C.B., Tai G.G., Palermo T.M. Presurgical psychosocial predictors of acute postsurgical pain and quality of life in children undergoing major surgery. J Pain. 2015; 16(3): 226–234. DOI: 10.1016/j.jpain.2014.11.015

20. Spielberger C.D., Gorsuch R.L., Lushene R.E. Manual for the State-Trait Anxiety Inventory. 1970. Palo Alto, CA: Consulting Psychologists Press. 24 p.