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A prospective controlled outcome study of psychological change following plastic surgery

A prospective controlled outcome study of psychological change following plastic surgery. Dr Tim Moss Chartered Health Psychologist Centre for Appearance Research UWE (Bristol) Tim.moss@uwe.ac.uk. Mr David Harris Consultant Plastic Surgeon Derriford Hospital Plymouth. Overview.

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A prospective controlled outcome study of psychological change following plastic surgery

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  1. A prospective controlled outcome study of psychological change following plastic surgery Dr Tim Moss Chartered Health Psychologist Centre for Appearance Research UWE (Bristol) Tim.moss@uwe.ac.uk Mr David Harris Consultant Plastic Surgeon Derriford Hospital Plymouth

  2. Overview • Evidence of plastic surgery benefits? • Design and measures • Participants and attrition • Outcomes • Depression • Anxiety • Appearance adjustment

  3. Evidence of plastic surgery success • Honigman et al 2004 review • Mixed methodologies • Patient satisfaction good • Bolton et al (2003) • Abdominoplasty, pre- and post-op • B.I. satisfaction increased • B.I. investment, general psych function not improved • Sarwer et al (2005) • General aesthetic plastic surgery • Satisfaction with surgery and ‘feature’ change over 12 months

  4. Methodological issues • Measures • Sarwer (1998) • Interviews demonstrate psychopathology in cosmetic surgery patients • Standardised general measures not identify this • Designs - comparison groups . . . • Dissonance • Hawthorn effect • Demand

  5. Our study: Design • Prospective, Controlled, quasi-experimental • Plastic surgery patient group • T1 (pre op), T2, (3 months post op), T3 (12 months post op) • Comparison surgery group • T1 and T2 • Participants • Adults, English speaking • Patients: • Plastic surgery admissions – nose, breasts, upper limb • Comparison group: • Non-appearance altering surgery group • General surgery, ENT, Maxillofacial surgery • Randomly allocated “nose”, “breasts”, “upper limb”

  6. Measures • Generic psychological functioning • Crown Crisp Experiential Inventory- Anxiety • Beck Depression Inventory • Test-retest reliability high • Good internal validity • Criterion validity with other measures and clinical observation high

  7. Measures Derriford Appearance Scale 24 www.derriford.info • 24 items examine frequency of avoidant behaviours and distress related to appearance concern • Example items: • I feel self conscious of my appearance • I avoid going to pubs/restaurants • Psychometric properties • Internal consistency; Cronbach's = 0.92 • Test-retest r = 0.68 (6 months) • Moderate correlations (r=0.5) with NA, social anxiety, shame

  8. Participant numbers

  9. Participants by condition

  10. Participant by sex (% Female) Gender similar across times and patient group

  11. Participant age Age comparable across groups and conditions

  12. Impact of Attrition Neither age nor sex differentially affected by attrition

  13. Depression Time x feature x group F(2,77) = 1.3, p=0.28 Depression reduction not significantly greater in plastics F(1,77)=2.3, p=0.13

  14. Anxiety • Time x group x feature • F(2,75)=3.1, p>0.05 • Anxiety reduction post op greater in plastics patients • F(2,75)=3.3, p=0.02

  15. Derriford Appearance Scale 24 • Time x feature x group • F(2,77)= 10.2, p<0.005 • Group X time • F(1,77) = 69.8, p<0.005 • Plastics patients significantly better DAS post op

  16. Derriford Appearance Scale by feature • Feature x time • F(2,23)=7.1, p<0.005 • DAS improvements post op only significant for rhino and breasts at T2

  17. Patients only: DAS at T2 - T3 • Stability of adjustment levels rhino and breasts • Delayed improvement in upper limb adjustment: significant T2 – T3 change

  18. Criticisms of design • Quasi-experimental design • Potential confounding of group • Limitation of plastics patient conditions impacts on generalisability • Groups numbers reduce analytical power

  19. Conclusions • Plastic surgery: psychological benefits for the three conditions studied • Plastic surgery specific, not generalised surgical intervention effect • Not demonstrated in depression • Small and significant effect in anxiety • Clear effect detected for DAS24 • Delayed benefit for upper limb • Use of appearance specific measures preferable to generic?

  20. Further work • Components of poor appearance adjustment benefiting from surgery? • Relationship between anxiety/DAS24/depression and Patient Satisfaction? • Impact of surgery on components of (multidimensional) BI - and which of these mediate outcome variables above?

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