The Pre-Surgical Psychological Evaluation Process

Why are Psychological Assessments (or Evaluations) Required Before Undergoing Surgery?


Psychological Assessments are often required for specific surgeries, such as Spinal Cord Stimulation (SCS) surgery and Bariatric surgery, among others.


They’re used not only to identify factors that may interfere with a positive outcome of the surgery but also to assess the readiness of the patient to undergo surgery and willingness to make the necessary lifestyle adjustments after the procedure.


The results of Psychological Assessments have been proven to correlate with the success of the surgery. The more mental and physical stress an individual is under (or has experienced in the past), the less likely the surgery will be beneficial.


Pre-existing Conditions

Pain and mental health play significant roles in determining whether or not an individual is a good candidate for surgery. Pain is experienced differently by different people.


The Central Texas Spine Institute reports that studies have shown that the more pain-sensitive a person is, the less likely the surgery, such as SCS, will have a positive outcome. Plus, the more prolonged pain is experienced, and the older the patient is, the less likely the result of the surgery will be favorable.


Besides these physical factors, psychological health plays a vital role in the success of the surgery. Some of these mental health concerns include:

  • Depression

  • Anxiety

  • Substance abuse

  • Trauma

  • No social support system

Two tiers of risk factors can be identified—Red Flags and Yellow Flags.


Red Flags (Primary Risk Factors) Include:

  • Suicidal, homicidal or psychotic tendencies

  • Active substance abuse

  • Severe psychological instability (above a 99 percentile)

If a red flag is detected, it’s recommended that the patient not have the surgery at this time (in elective cases). A reassessment can be done after addressing the current psychological concerns.


Yellow Flags (Secondary Risk Factors) include:

  • Depression

  • Anxiety

  • Coping with pain

  • Poor physical functioning

  • Somatization

  • Job dissatisfaction, etc

Almost all patients have more than one secondary risk factor. It’s the number of these risk factors that can affect the ultimate results of the surgery. The more secondary risk factors there are, the less likely the patient will have a successful outcome.


The presence of 4 or more risk factors increases the risk of a mental health disorder by 14% and increases the risk of the patient not returning to work by 50%.

How Does an Evaluation Work?

Before a patient is cleared for surgery, a physician may refer a patient to a mental healthcare professional for a clinical interview and psychological testing. The purpose is to determine if they are a good candidate for a specific surgery, such as SCS implantation or Bariatric surgery. Although each mental health therapist may use their own testing and evaluation variation, the process below is common.


The Process

The evaluation process includes gathering information on the patient’s:

  • Health history

  • Pain history

  • Psychosocial history

  • Mood and mental health status

  • Understanding and expectations of the procedure

Various assessment tools are used to determine the patient's candidacy for the surgery. Some of these tools include:

  • A Clinical Interview

  • A Health Psychology Intake Form

  • A Pain Intensity Test

  • A Mini Mental Status Exam

  • An Anxiety Inventory

  • A Beck Depression Inventory

  • A Suicide Assessment

The Recommendation

Based on the findings of all the information gathered, a recommendation for or against the surgery is determined. Along with this recommendation, additional suggestions may be advised, such as psychological counseling and pain management classes. Specific recommendations for the patient may include:

  • Working with a psychiatrist to manage medication

  • Participating in psychotherapy to improve mood from depression and anxiety

  • Exercising and stretching to improve mental and physical health

  • Starting an anti-inflammatory diet

  • Education about the emotional component of pain and building coping skills for chronic pain

  • Education about sleep hygiene

  • Reevaluating after implementing psychosocial and behavioral treatments

It’s important to note that if a surgery prospect is not recommended for surgery at the initial evaluation, the assessment can be repeated after addressing concerns that may prevent the patient from getting the most out of the procedure.