Combining mental health coaching with medication optimization significantly reduces anxiety and depression in older adults recovering from major surgery, according to a clinical trial published September 9 in JAMA Network Open. Led by researchers at Washington University School of Medicine in St. Louis, the trial demonstrates that preparing the mind for invasive procedures is just as critical as physical conditioning.
Addressing Perioperative Psychological Distress
Traditional perioperative care focuses almost exclusively on physical healing, frequently leaving emotional distress untreated. According to Dr. Eric J. “We recognize the importance of getting the body into shape before surgery, but preparing the mind and the brain is just as important,” Lenze said, noting that emotional well-being and medication management help deliver better post-surgical outcomes.
Structure of the Clinical Trial and Intervention
The trial evaluated 306 adults aged 60 and older scheduled for cardiac, oncologic, or orthopedic procedures across the BJC HealthCare system. Participants reporting mild to moderate symptoms of depression and anxiety were randomly assigned to either an intervention group or a control group. According to the study, patients in the intervention group received educational materials on mindfulness, sleep, and brain health alongside eight to 12 phone sessions with a dedicated wellness coach, such as a social worker or mental health counselor. Pharmacists and physicians also provided a personalized medication review to safely optimize doses of high-risk drugs.
Older patients frequently take multiple medications affecting the brain—including sedatives, muscle relaxants, and over-the-counter sleep aids. Without routine re-evaluations, these prescriptions accumulate, raising the risk of confusion, dangerous falls, and long-term physical pain after an operation. The control group received standard educational materials only.
Bridging Anesthesiology and Psychiatry
The trial was conducted through WashU Medicine’s Center for Perioperative Mental Health, which aims to integrate holistic mental health care into routine surgical medicine. Joanna Abraham, PhD, a professor in the Department of Anesthesiology at WashU Medicine and first author of the study, emphasized the timing of the intervention. “The time around surgery is a window of both risk and opportunity,” Abraham said, explaining that the stress of surgery worsens symptoms but also creates a critical opening to connect patients with necessary support. Michael S. Avidan, MBBCh, of WashU Medicine, added that the findings offer a practical blueprint for hospital systems nationwide to combine anesthesiology and psychiatry for more holistic patient care.
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