Influence of Preoperative Cognitive Function, Self-Efficacy, and Postoperative Psychological Counselling on Anxiety and Depression Levels in Patients Undergoing Botulinum Toxin Injections

Abstract

Background: To investigate the prognostic influence of preoperative cognitive function, self-efficacy, and postoperative psychological counselling on treatment response following botulinum toxin injections in patients with anxiety and depressive disorders, and to identify key predictors of treatment response.

Methods: A retrospective study was conducted on 176 patients who received botulinum toxin injections at Huzhou Maternity and Child Health Care Hospital between May and December 2025. Based on the treatment response of anxiety and depressive symptoms assessed eight weeks post-injection, participants were categorised into a responder group (n = 108) and a non-responder group (n = 68). Data collect included demographic characteristics, botulinum toxin injection details, psychological counselling records, pre-injection assessment of cognitive function and self-efficacy. Pearson correlation analysis was used to assess the relationship between preoperative cognitive levels and self-efficacy, and the effectiveness of postoperative psychological counselling on treatment outcomes of anxiety and depression. Multivariate logistic regression analysis was employed to identify factors influencing treatment response to anxiety and depression, and receiver operating characteristic (ROC) curves were used to evaluate the predictive performance of these factors.

Results: Both study populations exhibited negative correlations between preoperative Pittsburgh Sleep Quality Index (PSQI) scores and Hamilton Anxiety Rating Scale (HAMA) reduction rates, as well as Hamilton Depression Rating Scale (HAMD) reduction rates. Conversely, preoperative Montreal Cognitive Assessment (MoCA) scores, preoperative self-efficacy, and duration per session showed positive correlations with HAMA reduction rates and HAMD reduction rates (all p < 0.05). Multivariate logistic regression analysis revealed that counselling frequency (OR = 3.808, β = 1.337), duration per session (OR = 1.092, β = 0.088), preoperative PSQI score (OR = 0.820, β = −0.198), MoCA (OR = 1.312, β = 0.272), and General SelfEfficacy Scale (GSES) score (OR = 1.175, β = 0.161) were identified as factors influencing treatment response of anxiety and depression following botulinum toxin injection (p < 0.05). ROC curve analysis indicated that the aforementioned variables possessed predictive value for treatment response. The combined predictive model yielded an area under the curve was 0.866 (95% confidence interval, ranging from 0.810 to 0.921).

Conclusions: Preoperative cognitive function, selfefficacy and the duration per session were correlated with treatment response rates for anxiety and depression. Injection sites, counselling sessions, the duration per session, and preoperative PSQI, MoCA and GSES scores were identified as independent factors influencing treatment response following botulinum toxin injection.