Perceived self-efficacy, functional ability, and depressive symptoms in older elective surgery patients

Decline in functional ability as a consequence of medical illness or surgery has been associated with the development of depressive symptoms in older patients. Little is known about the influence of psychological variables on the relationship between postoperative functional ability and depressive symptoms in older adults. Inclusion of perceived self-efficacy in a theoretical model of the relationship of functional ability and depressive symptoms would extend knowledge and inform health care providers about specific risk factors for the development of postoperative depressive symptoms in older elective surgery patients.

The purpose of this longitudinal study was to test a theoretical path model of the effects of perceived self-efficacy and functional ability on depressive symptoms in older adults after major elective surgery.

Seventy-six older adult inpatients (60% women; mean age = 72.3 years, SD = 5.06) who had undergone elective total hip replacement surgery participated in a face-to-face interview 4 to 5 days after surgery (Time 1) and a telephone interview 6 weeks after surgery (Time 2). Perceived self-efficacy was measured by the Self-Efficacy Expectation Scale, functional ability by the Functional Status Index, and depressive symptoms by the Geriatric Depression Scale.

Path analysis revealed that Time 1 perceived self-efficacy had a direct, negative effect on Time 2 depressive symptoms. Time 1 perceived self-efficacy also had an indirect effect on Time 2 depressive symptoms through its positive effect on Time 2 functional ability.

The findings suggest that interventions to enhance older patients' perceived self-efficacy while hospitalized after elective total hip replacement surgery may enhance functional ability, which in turn may decrease the likelihood of depressive symptoms postoperatively.