Table 1.

Details on adapted perioperative mental health bundle components ( [42])

Intervention Bundle	Behavioral Activation	Medication Optimization and Deprescription
Interventionist	Trained social worker	Trained social worker and pharmacy team consisting of pharmacists and a geriatric psychiatrist
Description	Behavioral psychotherapy that helps depressed and anxious patients through identifying and tracking enjoyable and meaningful activities guided by personal goals and priorities [43].	Pharmacotherapy that helps to adjust suboptimal psychotropic dosages, deprescribe unnecessary or harmful medications, and ensure psychotropic continuation across the perioperative period [44, 45].
Core active components	• Identify patient’s personalized rationale • Define patient’s values and assess goals • Schedule activities of interest • Monitor progress of activities	• Review patient’s medications • Identify the patient’s likely need for, and interest in, a medication adjustment • Suggest medication adjustments • Assess the response to that adjustment • Coordinate with hospital team to ensure medication changes introduced pre-operatively are maintained in-house • Ensure medication changes are reconciled during transitions of care
Flexible components	• Selected behavioral activation activities: depending on patient needs and preferences • Timing: Pre-operative and post-operative phases • Format: 1:1 (patient-specific activities); group sessions (to share experiences with others and hear about other stories – peer-motivation) • Duration: 20–60 min • Frequency of sessions: 1–4 (pre-op); 2–12 (post-op) • Setting: In-person (first time –surgeon clinic/pre-op counseling class), telephone, and zoom (video)	• Suggest medication changes only if patient is comfortable • Timing: Pre-operative and post-operative phases (start as early as possible) • In-hospital care: Pharmacy team coordinates with in-hospital team to ensure continuity of care • Format: 1:1 session • Duration: 5 min • Frequency of sessions: 1–4 (pre); 2–12 (post) • Setting: In-person (first time); telephone; zoom (video) or in-person (for remaining sessions)