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Postoperative Depression, Anxiety, and Stress in Relation to Health-Related Quality of Life Among Patients Undergoing
Wael Al-Tamimi1, Majdi Alhadidi1, Omar Alqaisi2
1Faculty of Nursing, Al- Zaytoonah University of Jordan (ZUJ), Amman, Jordan.
Background:
Up to 25% of patients undergoing total knee replacement (TKR) for end-stage knee osteoarthritis report persistent pain, functional limitation, and reduced health-related quality of life (HRQoL). Although depression, anxiety, and stress are recognized determinants of surgical outcomes, their postoperative impact remains poorly studied in the Arab world, with no multicenter data from Jordan.
Objectives:
This study aimed to assess the postoperative depression, anxiety, and stress and their association with HRQoL among TKR patients in Jordan, and to identify independent predictors of HRQoL.
Methods:
A cross-sectional descriptive correlational design was used. A total of 140 adults were recruited from two government orthopedic hospitals in Jordan. Assessments were conducted at a single postoperative time point, 6-12 weeks following TKR surgery. Postoperative depression, anxiety, and stress were measured using the validated Arabic DASS-21 (α = 0.94), and HRQoL was assessed using the Arabic SF-12 (α = 0.84). Data were analyzed using descriptive statistics, Pearson correlation, and stepwise multiple linear regression.
Results:
Participants demonstrated moderate depression (M = 18.66, SD = 7.18) and anxiety (M = 14.13, SD = 7.63), and mild stress (M = 17.17, SD = 7.65) post-TKR. The mean HRQoL score was 39.56 (SD = 10.07). A statistically significant negative correlation was found between psychological distress and HRQoL (r = -0.27, p = 0.001). Multiple regression identified body mass index (BMI) (B = -0.382, p < 0.001) and postoperative psychological distress (DASS-21 total score; B = -0.054, p < 0.001) as independent predictors of HRQoL, explaining 17.7% of total variance. Educational level and comorbidities were significantly associated with postoperative depression, anxiety, and stress.
Conclusion:
Postoperative TKR patients in Jordan demonstrated poor overall HRQoL alongside moderate psychological distress. Routine psychological screening and targeted multidisciplinary interventions addressing modifiable factors such as BMI and psychological distress may help improve patient outcomes following TKR.
