# Dysphonia coping strategies, vocal handicap and anxiety/depression symptoms in pre and post-thyroidectomy patients

## TL;DR

This study examines how patients cope with voice issues and anxiety/depression before and after thyroid surgery, finding emotional coping strategies and fluctuating anxiety levels.

## Contribution

The study provides insights into the psychological and coping dynamics of dysphonia in thyroidectomy patients over time.

## Key findings

- Patients primarily use emotion-focused coping strategies for dysphonia.
- Mild anxiety is reported preoperatively, decreases shortly after surgery, but increases after three months.
- Strong correlations between coping strategies and anxiety are observed in the immediate postoperative period.

## Abstract

To analyze coping strategies for dysphonia, vocal handicap, and anxiety/depression symptoms in patients undergoing thyroidectomy.

A retrospective study with patients evaluated preoperatively, recently postoperatively, and three months post-thyroidectomy. Data from the Brazilian version of the Voice Disability Coping Questionnaire (B-VDCQ), Vocal Handicap Index (VHI), and Hospital Anxiety and Depression Scale (HADS) were analyzed. Patients with language, neurological, laryngeal, thyroid hormonal, or reflux disorders were excluded.

A total of 20 patients participated (mean age 54 years, SD±16.9), predominantly female (n=17; 85%), with partial thyroidectomy (n=14; 70%). In B-VDCQ, scores decreased between preoperative, recent postoperative, and three-month postoperative assessments, especially in the emotional focus domain, with no significant differences over time. In VHI, the organic domain had the highest scores, indicating mild vocal handicap without differences across assessments. In HADS, mild anxiety traits were observed preoperatively, reduced shortly after surgery, but increased after three months, while depression remained within normal limits. Preoperatively, a moderate positive correlation was found between depression and the organic and total VHI domains. In the recent postoperative period, anxiety showed a weak/moderate positive correlation with B-VDCQ and VHI. After three months, B-VDCQ had a moderate positive correlation with anxiety and total HADS, and a weak correlation between the "functional" and "organic" VHI domains and depression.

Patients primarily use emotion-focused coping strategies, self-report mild vocal handicap, and exhibit mild anxiety traits preoperatively, which decrease postoperatively but increase after three months. The strongest correlations occurred in the immediate postoperative period.

Analisar estratégias de enfrentamento na disfonia, desvantagem vocal e sintomas de ansiedade/depressão em pacientes submetidos à tireoidectomia.

Estudo retrospectivo com pacientes avaliados no pré-operatório, pós-recente e 3 meses pós-tireoidectomia. Analisou-se os protocolos Estratégia de Enfrentamento na Disfonia (PEED-27), Índice de Desvantagem Vocal (IDV) e Hospital Anxiety and Depression Scale (HADS). Foram excluídos pacientes com alterações de linguagem, neurológicas, laríngeas, hormonais tireoidianas e refluxo.

Participaram 20 pacientes, média de idade de 54 anos (DP±16,9), prevalência de sexo feminino (n=17;85%), tireoidectomia parcial (n=14;70%). No PEED-27, houve redução dos escores entre o pré e o pós-recente e o pós 3 meses, com destaque no foco emocional, sem diferença nos momentos. No IDV, o domínio orgânico foi o mais pontuado, com desvantagem leve sem diferença nos momentos. No HADS, houve traços leves de ansiedade no pré-operatório, redução no pós-recente, aumento após três meses e traços normais para depressão. No pré-operatório, houve correlação positiva moderada entre depressão e domínios orgânico e total do IDV. No pós-recente, ansiedade apresentou correlação positiva fraca/moderada com PEED-27 e IDV. Após 3 meses, PEED-27 apresentou correlação positiva moderada com ansiedade e domínio total da HADS e correlação positiva fraca entre os domínios “funcional” e “orgânico” do IDV com depressão.

Os pacientes utilizam estratégias de enfrentamento com foco na emoção, autorreferem desvantagem vocal leve e traços leves de ansiedade no pré-operatório, redução no pós-recente e aumento pós três meses. Houve correlação positiva entre enfrentamento e desvantagem vocal com ansiedade, principalmente no pós-recente, período com relações mais relevantes.