Researchers have indicated the need for consideration of emotional distress prior to surgery. Measures of pre-operative anxiety have been developed and include the Pre-operative Intrusive Thoughts Inventory (PITI). The aim of the present study is to evaluate the application of the PITI in a mid- to older-adult population awaiting elective hernia repair. A cross-sectional design was employed to examine whether anxiety, depression, previous surgical history and personality characteristics modified intrusive thoughts. Twenty-one participants were recruited and assessed in hospital before surgery. Measures of state anxiety, neuroticism, psychoticism and negative surgical history correlated with the PITI or its subscales. However, lower levels of pre-operative distress as assessed by the PITI were found in the present sample when compared to mean scores in the original study and reasons for these findings are proposed. Results indicate the importance of assessment of pre-operative functioning and the association of psychological and personality characteristics in responses to surgery.