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Feb 2013, Vol 148, No. 2 >

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Original Article | Feb 2013 ONLINE FIRST

Parathyroidectomy, Elevated Depression Scores, and Suicidal Ideation in Patients With Primary Hyperparathyroidism:  Results of a Prospective Multicenter Study

Theresia Weber, MD; Julia Eberle, MD; Ursula Messelhäuser, MD; Leif Schiffmann, MD; Christoph Nies, MD; Jochen Schabram, MD; Andreas Zielke, MD; Katharina Holzer, MD; Edit Rottler; Doris Henne-Bruns, MD; Monika Keller, MD; Jörn von Wietersheim, MD
JAMA Surg. 2013;148(2):109-115. doi:10.1001/2013.jamasurg.316.
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Objective  To assess anxiety and depression symptoms, suicidal ideation, and health-related quality of life (HRQOL) in a large series of consecutive patients with primary hyperparathyroidism (pHPT) before and after parathyroidectomy.

Design  This prospective multicenter study investigated preoperative and postoperative depression, anxiety, suicidal ideation, and HRQOL in patients with pHPT and compared these variables with a control group with nontoxic thyroid nodules.

Patients  The study included 194 patients with pHPT and 186 control subjects.

Main Outcome Measures  Depression was evaluated with the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire–9, which also assessed suicidal ideation. Anxiety was evaluated with the HADS. Health-related quality of life was measured with the 36-Item Short Form survey.

Results  Parathyroidectomy achieved a 98% cure rate. Preoperatively, severe depression (HADS score ≥11) was seen in 20% of the pHPT group and 9% of the control group. The Patient Health Questionnaire–9 detected moderate to severe depression in 17% of the patients with pHPT and 7% of the control subjects. Patients with pHPT had higher HADS anxiety scores (mean, 7.7) than control subjects (P < .01) or the German normative sample (P < .001). Compared with control subjects, patients with pHPT had significantly lower 36-Item Short Form survey preoperative physical and mental health summary scores (42.7 vs 49.5 and 41.2 vs 46.8, respectively; P = .001 for both comparisons). At 12 months follow-up, depression and anxiety decreased significantly in patients with pHPT; the prevalence of suicidal ideation was more than halved from the baseline (10.7% vs 22%; P = .008). Both physical and mental health scores (45.7 and 47.7, respectively) improved in patients with pHPT (P < .001 each) but not in control subjects.

Conclusions  Depression, anxiety, and decreased HRQOL appear to be related to pHPT. Successful parathyroidectomy seems to reduce psychopathologic symptoms and improve HRQOL in this setting.
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Figure 1. Anxiety and depression scale scores. A, Hospital Anxiety and Depression Scale (HADS) scores of preoperative and postoperative symptoms of anxiety among patients with primary hyperparathyroidism (pHPT) and thyroid disease (control group). B, HADS preoperative and postoperative symptoms of depression scores among patients with pHPT and thyroid disease (control group). * P < .01; † P < .001; comparisons were made between admission and assessment point (Wilcoxon test).

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Figure 2. Graph showing the increasing percentage of patients with no depression in the group with primary hyperparathyroidism (pHPT) vs no difference in the group with thyroid disease, according to the Patient Health Questionnaire–9 (PHQ-9) scores.

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Figure 3. Preoperative and postoperative responses to item 9 of the Patient Health Questionnaire–9 (PHQ-9): “thoughts that you would be better off dead or hurting yourself in some way.” pHPT indicates primary hyperparathyroidism.

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Figure 4. Physical and mental component scores. A, Preoperative and postoperative health-related quality of life measured with the 36-Item Short Form (SF-36) physical component score for patients with primary hyperparathyroidism (pHPT) and thyroid disease (control group). B, Preoperative and postoperative health-related quality of life measured with the SF-36 mental component score for patients with pHPT and thyroid disease (control group). * P < .05; † P < .01; ‡ P < .001; comparisons were made between admission and assessment point (Wilcoxon test).

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