Inclusion Criteria Patient Participants  Age ≥60 years on the day of surgery; Scheduled major orthopedic surgery, or major surgical resection of a thoracic or abdominal malignancy, or major cardiac procedure; Clinically significant depression or anxiety symptoms screened by the PHQ-ADS (Patient Health Questionnaire Anxiety and Depression Scale) ≥10  Exclusion Criteria Patient Participants  Estimated life expectancy < 12 months; Unable to read, speak, and understand English; Current alcohol or other substance abuse; Severe cognitive impairment screened by the SBT (Short Blessed Test) >10; Acutely suicidal