BRIA - Bridging Intervention in Anesthesiology

The primary objective of this study is to investigate the efficacy of psychotherapeutic contacts that aim at motivating and supporting surgical patients with psychiatric disorders in participating in subsequent psychosocial treatment options like psycho- and addiction therapy (RCT). The secondary objective is to investigate whether preoperatively assessed psychosocial factors are associated with surgical outcomes (preoperative computer-assisted self assessment).

The Bridging Intervention in Anesthesiology (BRIA) has been designed as a feasible treatment option to reach patients from all surgical fields. Implemented in the preoperative anesthesiological assessment clinic this therapy program comprises two major elements: (1) A computer assisted self assessment of social, lifestyle and psychological factors including a comprehensive battery of psychiatric screening tests; (2) Psychotherapeutic contacts with the objective to motivate patients with psychiatric disorders and support them in participating in subsequent psychosocial treatment programs. The self assessment will be offered to all adult surgical patients of the preoperative anesthesiological assessment clinic during inclusion period (current 5104 patients). Data on surgical outcomes will be collected prospectively during a 6-month-follow-up, and regression analyses will be performed to determine the extent of associations between psychosocial factors and outcomes. Patients with clinically relevant psychological distress (i.e. scoring above the cut-off of one of applied standardized screening questionnaires) will be offered to participate in the RCT on the psychotherapy part of BRIA (220 patients). Data on primary and secondary outcomes will be collected 6 months and 24 months, respectively, after baseline assessment.

Inclusion and exclusion criteria for participating at the preoperative computer-assisted self assessment were defined as follows:

Inclusion criteria

• Written informed consent to participate in the first part of study after having been properly instructed
• patient of the preoperative anesthesiological assessment clinic
• age ≥18 years.

Exclusion criteria

• Surgery with an emergency or urgent indication
• inability to attend the preoperative assessment clinic (bedside visit)
• insufficient knowledge of German language
• members of the hospital staff
• admitted in police custody
• accommodation in an institution by official or court order
• being under guardianship
• psychiatric, neurological or other condition associated with limited legal capability or limited capability of being properly instructed or giving informed consent.

Additional inclusion and exclusion criteria of the RCT (Enrollment: 220 patients) were defined as follows:

Inclusion criteria

• Written informed consent to participate in the RCT after having been properly instructed
• acute significant psychiatric distress (scoring above of at least one of the cut-off values of WHO-5, PHQ-2, GAD-2, HADS-D, HADS-A, AUDIT) and/or being tobacco smoker, and/or having consumed illicit drugs during the last 12 months.

Exclusion criteria

• Acute severe psychiatric condition (acute episode of psychotic disorder, severe substance use disorder including serious withdrawal symptoms)
• severe acute suicidality
• homelessness
• participation in a psychopharmacological clinical trial at baseline assessment or 1 month before, respectively.