Table 4 Depression and anxiety
Author Year Country | Study design | Number of patients | Withdrawals—dropouts | Intervention Breast reduction Mean (SD) | Control No surgery Mean (SD) P values of intergroup difference if not state otherwise | Comments | Directness* | Study limitations* | Precision* |
|---|---|---|---|---|---|---|---|---|---|
Beraldo 2016 Brazil [41] | RCT | I: 30 C: 30 | I: 1 C: 3 | Depression score (BDI) Baseline: 12.4 (9.0) 3 months: 10.2 (9.9) 6 months: 7.2 (9.9) Intragroup change: Baseline to 3 and 6 months p < 0.001 | Depression score (BDI) Baseline: 13.2 (9.6) p = 0.89 3 months: 13.0 (8.5) p = 0.12 6 months: 13.7 (10.5) p = 0.01 Intragroup change: Baseline to 3 and 6 months p = 0.89 | Beck Depression Inventory (BDI) (21 items, range 0–63, higher score indicates worse depression)  < 10 = no or minimal depression 10–16 = mild depression 17–29 = moderate depression 30–63 = severe depression A MID of 17.5% of the total score (11 points) has been suggested for BDI [63] | ? | ? | ? |
Iwuagwu 2006 UK [39] | RCT | I: 36 C: 37 | 0 | Depression score Baseline: 0.69 (0.30) 4 months: 0.39 (0.27) Proportion depressed (no. (%)): Baseline: Normal score: 28 (78) Borderline score: 6 (17) Abnormal score: 2 (6) 4 months: Normal score: 34 (94) Borderline score: 1 (3) Abnormal score: 1 (3) | Depression score Baseline: 0.70 (0.29) 4 months: 0.79 (0.27) p < 0.001 Proportion depressed (no. (%)): Baseline: Normal score: 27 (73) Borderline score: 8 (22) Abnormal score: 2 (6) 4 months: Normal score: 25 (67) Borderline score: 10 (27) Abnormal score: 2 (6) p < 0.001 | Hospital Anxiety and Depression Scale (HADS) (7 items, range 0–21. Higher score indicates worse depression) 0–7 ‘normal’ 8–10 ‘borderline’  ≥ 11 ‘clinical depression/anxiety’ Depression scores were transformed to appropriate a Gaussian distribution (1 + log 10) A MID of 1.7 has been suggested for HADS [64] | ? | ? | ? |
|  |  |  |  | Anxiety score Baseline: 9.1 (3.9) 4 months: 5.0 (3.5) Baseline: No (%) Normal score: 12 (33) Borderline score: 11 (31) Abnormal score: 13 (36) | Anxiety score Baseline: 9.1 (4.0) 4 months: 9.6 (3.8) p < 0.001 Baseline: No (%) Normal score: 12 (32) Borderline score: 11 (30) Abnormal score: 14 (38) |  |  |  |  |
|  |  |  |  | 4 months: Normal score: 30 (83) Borderline score: 4 (11) Abnormal score: 2 (6) | 4 months: Normal score: 10 (28) Borderline score: 10 (28) Abnormal score: 17 (47) p < 0.001 MD 4.6 |  |  |  |  |
Saariniemi 2009 Finland [57] | RCT | I: 40 C: 42 | I: 11 C: 7 | RBDI Depression Baseline: 5 (2.5–6.5) 6 months: 0 (0.0–2.5) Median (interquartile) | RBDI Depression Baseline: 4 (1.0–8.0) 6 months: 4 (0.0–7.0) p < 0.01 Median (interquartile) | RBDI: Raitasalo’s modification of the short form of the Beck Depression inventory (range 0–39, lower better) 5–7: mild depression 8–15: moderate depression  > 16: severe depression | ?/ +  | ? |  +  |
|  |  |  |  | Proportion depressed (no. (%)): Baseline: 16 (55) 6 months: 2 (7) | Proportion depressed (no. (%)): Baseline: 15 (43) 6 months: 15 (43) p < 0.01 | Proportions: Depressed = RBDI depression score > 4 |  |  |  |
|  |  |  |  | Anxiety No. (%) Baseline: 18 (62) 6 months: 3 (10) | Anxiety No. (%) Baseline: 18 (51) 6 months: 12 (34) p = 0.04 MD 9 |  |  |  |  |