Psychiatric screening for patients with faecal incontinence or chronic constipation referred for surgical treatment

Fifty patients attending for surgical treatment of chronic constipation (n = 21) or faecal incontinence (n = 29) were studied using two psychiatric screening tests: the Hospital Anxiety and Depression (HAD) scale and the General Health Questionnaire (GHQ). Each patient was assessed preoperatively and 6–12 months postoperatively. Results were compared with age and sex-matched controls (n = 50). Constipated patients had significantly higher HAD depression scores compared with controls (median and range): 6 (2–12) versus 4 (0–8), P < 0·05. Constipated patients who were improved by operation (n = 13) had significantly lower preoperative HAD anxiety scores compared with those who were not improved (n = 8): 8 (3–14) versus 15 (10–19), P < 0·01; they also had significantly lower HAD depression scores: 4 (2–12) versus 7 (5–11), P < 0·05. Using these parameters incontinent patients did not differ from controls, but patients who had a bad result after operation (n = 15) had significantly higher HAD anxiety scores than those who obtained clinical benefit (n = 14): 10 (2–15) versus 6 (2–12), P < 0·05; HAD depression scores were also greater: 5 (2–15) versus 3 (0–9), P < 0·05; and GHQ scores were greater: 12 (0–47) versus 4 (0–41), P < 0·05.