Center for Perioperative Mental Health

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Abstract/Project Summary – OVERALL The Center for Perioperative Mental Health will address a glaring deficiency in perioperative healthcare by creating a translational platform for improving the mental healthcare of older adults undergoing surgery and other invasive procedures. The World Health Organization defines health as a state of complete physical, mental, and social well-being. Although perioperative medicine has developed a strong emphasis on optimizing perioperative physical health and preventing major medical complications, the integration of mental healthcare into perioperative care has been perfunctory. This is highlighted by evidence that depression and anxiety are common perioperative problems that are inadequately managed in the perioperative setting; and surgical patients with depression and anxiety have substantially worse physical, mental and social outcomes. These negative consequences manifest as impaired long-term recovery and rehabilitation, with hospital readmissions, persistent depression and anxiety, and ultimately poor functional recovery and quality of life. Therefore, this Center for Perioperative Mental Health provides a timely intervention that will yield improved perioperative health outcomes for older adults who are especially vulnerable in this period. This transformation in care and outcomes will be actualized through the integration of evidence-based mental healthcare into the perioperative paradigm. We propose a combined behavioral and pharmacological intervention bundle targeting three key priority areas. First, we will provide behavioral activation, a flexible component of cognitive behavioral therapy and standalone treatment focusing on reinforcing activities. Second, we will optimize the pharmacological treatment of depression and anxiety. Third, we will deprescribe medications that are harmful for brain health. In order to overcome barriers to effective, implementable care, we will: (1) adapt, optimize and personalize treatment plans based on the heterogenous needs of different surgical patients; (2) test effectiveness of the treatments; and (3) speed their implementation in the real-world. The Center is structured to maximize the likelihood of success. This includes an experienced, administrative leadership core; a sophisticated, multi-disciplinary methodological infrastructure; a diverse team of clinical researchers and implementation scientists; and advisory boards with broadly representative stakeholders and internationally renowned experts. Three pragmatic trials in distinct surgical subpopulations will establish how best to implement the mental healthcare bundle in diverse surgical settings. Our vision for the Center for Perioperative Mental Health is a transdisciplinary platform to rapidly advance the science and practice of perioperative mental and cognitive healthcare. This Center has the potential for substantial public health impact by revolutionizing the approach to perioperative care, based on firm evidence and clinical translation.