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Rometsch C, Festl-Wietek T, Bäuerle A, Schweda A, Skoda EM, Schäffeler N, Stengel A, Zipfel S, Teufel M, Herrmann-Werner A. Anxiety and Somatoform Syndromes Predict Transplant-Focused Internet Use in the Course of an Organ Transplantation. Telemed J E Health 2024; 30:e1172-e1179. [PMID: 37902962 DOI: 10.1089/tmj.2023.0137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2023] Open
Abstract
Background: e-Health interventions are increasing in the field of organ transplantations; however, the literature lacks evidence regarding needs, attitudes, and preferences of organ recipients and donors during the course of an organ transplantation. Methods: In a cross-sectional study, 70 subjects were assessed using self-rated and validated questionnaires, such as the PRIME MD Patient Health Questionnaire (PHQ-D) and the Essen Resource Inventory (ERI). Group differences and a multiple linear regression were also applied. Results: Organ recipients had significantly higher scores for depression (U = 245.00, z = -2.65, p = 0.008, Cohen's d = 0.32), somatoform (U = 224.50, z = -2.99, p = 0.003, Cohen's d = 0.37), and stress syndromes (U = 266.00, z = -2.25, p = 0.008, Cohen's d = 0.27). They also named the internet and apps as resources to find information regarding organ transplants (U = 177.50, z = -2.07, p = 0.017, Cohen's d = 0.28; Z = -2.308, p = 0.021) and preferred to use apps to monitor the physical condition (Z = -2.12, p = 0.034) significantly more than organ donors. Anxiety and somatoform syndromes were significant predictors to search for information regarding the transplant process (F[6,38] = 3.98, p < 0.001; R2 = 0.386). Conclusions: e-Health interventions are promising in accompanying the course of an organ transplant for patients to be informed and educated. Predominantly, potential organ recipients might benefit from apps to record physical parameters. However, anxiety syndromes might hinder patients from searching for information about the transplant process, while somatoform syndromes might enable patients who are searching for such information.
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Affiliation(s)
- Caroline Rometsch
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
- Department of Experimental and Clinical Medicine, University of Florence, Firenze, Italy
| | - Teresa Festl-Wietek
- TIME-Tübingen Institute for Medical Education, Medical Faculty Tübingen, Tübingen, Germany
| | - Alexander Bäuerle
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Adam Schweda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Eva Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- West German Center for Organ Transplantation, University Hospital Essen, Essen, Germany
| | - Anne Herrmann-Werner
- TIME-Tübingen Institute for Medical Education, Medical Faculty Tübingen, Tübingen, Germany
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2
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Malgaroli M, Szuhany KL, Riley G, Miron CD, Park JH, Rosenthal J, Chachoua A, Meyers M, Simon NM. Heterogeneity of posttraumatic stress, depression, and fear of cancer recurrence in breast cancer survivors: a latent class analysis. J Cancer Surviv 2023; 17:1510-1521. [PMID: 35224684 PMCID: PMC10037701 DOI: 10.1007/s11764-022-01195-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 02/19/2022] [Indexed: 01/27/2023]
Abstract
PURPOSE Breast cancer survivors may demonstrate elevated psychological distress, which can also hinder adherence to survivorship care plans. Our goal was to study heterogeneity of behavioral health and functioning in breast cancer survivors, and identify both risk and protective factors to improve targets for wellness interventions. METHODS Breast cancer survivors (n = 187) consented to complete self-reported psychological measures and to access their medical records. Latent class analysis (LCA) was used to classify heterogeneous subpopulations based on levels of depression, post-traumatic stress, fear of cancer recurrence, cancer-related pain, and fatigue. Multinomial logistic regression and auxiliary analysis in a 3-step modeling conditional approach was used to identify characteristics of the group based on demographics, treatment history and characteristics, and current medication prescriptions. RESULTS Three subpopulations of breast cancer survivors were identified from the LCA: a modal Resilient group (48.2%, n = 90), a Moderate Symptoms group (34%, n = 65), and an Elevated Symptoms group (n = 17%, n = 32) with clinically-relevant impairment. Results from the logistic regression indicated that individuals in the Elevated Symptoms group were less likely to have a family history of breast cancer; they were more likely to be closer to time of diagnosis and younger, have received chemotherapy and psychotropic prescriptions, and have higher BMI. Survivors in the Elevated Symptoms group were also less likely to be prescribed estrogen inhibitors than the Moderate Symptoms group. CONCLUSIONS This study identified subgroups of breast cancer survivors based on behavioral, psychological, and treatment-related characteristics, with implications for targeted monitoring and survivorship care plans. IMPLICATIONS FOR CANCER SURVIVORS Results showed the majority of cancer survivors were resilient, with minimal psychological distress. Results also suggest the importance of paying special attention to younger patients getting chemotherapy, especially those without a family history of breast cancer.
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Affiliation(s)
- Matteo Malgaroli
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA.
| | - Kristin L Szuhany
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Gabriella Riley
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Carly D Miron
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
| | - Jae Hyung Park
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY, 10010, USA
| | - Jane Rosenthal
- Perlmutter Cancer Center, NYU Grossman School of Medicine, 160 E 34th St, New York, NY, 10016, USA
| | - Abraham Chachoua
- Perlmutter Cancer Center, NYU Grossman School of Medicine, 160 E 34th St, New York, NY, 10016, USA
| | - Marleen Meyers
- Perlmutter Cancer Center, NYU Grossman School of Medicine, 160 E 34th St, New York, NY, 10016, USA
| | - Naomi M Simon
- Department of Psychiatry, NYU Grossman School of Medicine, One Park Avenue, 8th Floor, New York, NY, 10016, USA
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3
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Freiberger A, Richter C, Huber M, Beckmann J, Freilinger S, Kaemmerer H, Ewert P, Kohls N, Henningsen P, Allwang C, Andonian-Dierks C. Post-Traumatic Distress in Adults With Congenital Heart Disease: an Under-Recognized Complication? Am J Cardiol 2023; 203:9-16. [PMID: 37478638 DOI: 10.1016/j.amjcard.2023.06.087] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/14/2023] [Accepted: 06/24/2023] [Indexed: 07/23/2023]
Abstract
The stressful and potentially traumatic perception of repeated hospitalization, outpatient check-ups, and medical interventions places a high stress burden on patients with congenital heart disease (CHD). These experiences can lead to post-traumatic stress symptoms (PTSSs). This study aimed to estimate the prevalence of PTSSs in adults with CHD (ACHDs) and to identify the associated risk factors. In this cross-sectional study, 234 ACHDs were recruited from November 2021 to August 2022 at a dedicated tertiary care center. Data were collected on general health, anxiety and depression, PTSSs, and on quality of life using validated and standardized questionnaires. In addition, the reasons for PTSSs were assessed using free-text responses. Overall, 17.1% to 20.5% (mean age: 35.2 ± 10.8 [18 to 66] years, 46.6% women) of the enrolled patients met the criteria for clinically relevant PTSSs related to their CHD or treatment. The associated risk factors (p <0.05) included preexisting mental distress (odds ratio [OR] 4.86), depression (OR 5.565) and anxiety (OR 3.36,), level of perceived mental distress during the traumatic event (OR 1.46), and number of medical procedures (OR 1.17). In addition, a worse clinical state was associated with more PTSSs (p = 0.018). Using free-text responses, the various reasons for PTSSs were identified, ranging from cardiac procedures to social stigma. In conclusion, the high prevalence of PTSSs calls for increased awareness of PTSSs in ACHDs in cardiovascular care. PTSSs and their associated disorder can adversely affect the manifestation and progression of cardiac disease. Thus, it is necessary to reflect upon psychocardiac prevention and intervention as an integral part of multidisciplinary cardiac care.
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Affiliation(s)
- Annika Freiberger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany.
| | - Cristina Richter
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Maximilian Huber
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Jürgen Beckmann
- Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; School of Human Movement and Nutrition Sciences, University of Queensland, Queensland, Australia; Health Research Institute, University of Limerick, Limerick, Ireland
| | - Sebastian Freilinger
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany; Chair of Preventive Pediatrics, Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany
| | - Harald Kaemmerer
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Peter Ewert
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany
| | - Niko Kohls
- Division of Health Promotion, Department of Social Work and Health, University of Applied Sciences Coburg, Coburg, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
| | - Christine Allwang
- Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
| | - Caroline Andonian-Dierks
- Department of Congenital Heart Disease and Pediatric Cardiology, German Heart Center Munich, Munich, Germany; Department of Sport and Health Sciences, Technical University of Munich, Munich, Germany; Department of Psychosomatic Medicine and Psychotherapy, School of Medicine, Technical University Munich, Munich, Germany
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4
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Varshney M, Dhingra K, Choudhury A. Psychosocial Assessment and Management-related Issues Among Liver Transplant Recipients. J Clin Exp Hepatol 2023. [DOI: 10.1016/j.jceh.2023.07.414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
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5
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Zimbrean PC, Andrews SR, Hussain F, Fireman M, Kuntz K, Niazi SK, Simpson SA, Soeprono T, Winder GS, Jowsey-Gregoire SG. ACLP Best Practice Guidance: Evaluation and Treatment of Depression in Solid Organ Transplant Recipients. J Acad Consult Liaison Psychiatry 2023; 64:357-370. [PMID: 37003570 DOI: 10.1016/j.jaclp.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 03/05/2023] [Accepted: 03/24/2023] [Indexed: 04/03/2023]
Abstract
We present Academy of Consultation Liaison Psychiatry best practice guidance on depression in solid organ transplant (SOT) recipients, which resulted from the collaboration of Academy of Consultation Liaison Psychiatry's transplant psychiatry special interest group and Guidelines and Evidence-Based Medicine Subcommittee. Depression (which in the transplant setting may designate depressive symptoms or depressive disorders) is a frequent problem among SOT recipients. Following a structured literature review and consensus process, the Academy of Consultation Liaison Psychiatry transplant psychiatry special interest group proposes recommendations for practice: all organ transplant recipients should be screened routinely for depression. When applicable, positive screening should prompt communication with the mental health treating provider or a clinical evaluation. If the evaluation leads to a diagnosis of depressive disorder, treatment should be recommended and offered. The recommendation for psychotherapy should consider the physical and cognitive ability of the patient to maximize benefit. The first-line antidepressants of choice are escitalopram, sertraline, and mirtazapine. Treating depressive disorders prior to transplantation is recommended to prevent posttransplant depression. Future research should address the mechanism by which transplant patients develop depressive disorders, the efficacy and feasibility of treatment interventions (both pharmacological and psychotherapeutic, in person and via telemedicine), and the resources available to transplant patients for mental health care.
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Affiliation(s)
- Paula C Zimbrean
- Department of Psychiatry and Surgery, Yale School of Medicine, New Haven, CT.
| | - Sarah R Andrews
- Department of Psychiatry, John Hopkins University, Baltimore, MD
| | - Filza Hussain
- Department of Psychiatry and Behavioral Sciences - Medical Psychiatry, Stanford University, Palo Alto, CA
| | - Marian Fireman
- Department of Psychiatry, Oregon Health & Science University, Portland, OR
| | - Kristin Kuntz
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Shehzad K Niazi
- Departments of Psychiatry and Psychology, Mayo Clinic Florida, Orlando, FL
| | - Scott A Simpson
- Department of Behavioral Health Services, Denver Health, Denver, CO
| | - Thomas Soeprono
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
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6
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Zimbrean PC. Depression in transplantation. Curr Opin Organ Transplant 2022; 27:535-545. [PMID: 36227755 DOI: 10.1097/mot.0000000000001024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW To review and summarize the literature published between 1 January 2020 and 30 June 2022, on the prevalence, risk factors and impact of depression in transplant population. RECENT FINDINGS Depression is common in transplantation candidates and recipients, with a prevalence up to 85.8% in kidney recipients. Multiple studies have indicated after transplantation depression correlates with increased mortality and with higher healthcare utilization. Social risk factors for posttransplant depression include financial difficulties and unemployment, while less is understood about the biological substrate of depression in this population. There is evidence that dynamic psychotherapy is effective for depression in organ transplant recipients, while cognitive behavioral therapy or supportive therapy did not lead to improvement of depression in transplant recipients. For living organ donors, the rates of depression are similar to the general population, with financial factors and the clinical status of the recipient playing a significant role. SUMMARY Depression is a common finding in transplant population. More research is needed to understand the biological substrate and risk factors and to develop effective treatment interventions.
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Affiliation(s)
- Paula C Zimbrean
- Departments of Psychiatry and Surgery (Transplantation), Yale University School of Medicine, New Haven, Connecticut, USA
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7
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022; 42:e1-e141. [PMID: 37080658 DOI: 10.1016/j.healun.2022.10.015] [Citation(s) in RCA: 73] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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8
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Velleca A, Shullo MA, Dhital K, Azeka E, Colvin M, DePasquale E, Farrero M, García-Guereta L, Jamero G, Khush K, Lavee J, Pouch S, Patel J, Michaud CJ, Shullo M, Schubert S, Angelini A, Carlos L, Mirabet S, Patel J, Pham M, Urschel S, Kim KH, Miyamoto S, Chih S, Daly K, Grossi P, Jennings D, Kim IC, Lim HS, Miller T, Potena L, Velleca A, Eisen H, Bellumkonda L, Danziger-Isakov L, Dobbels F, Harkess M, Kim D, Lyster H, Peled Y, Reinhardt Z. The International Society for Heart and Lung Transplantation (ISHLT) Guidelines for the Care of Heart Transplant Recipients. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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9
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Duncan-Park S, Danziger-Isakov L, Armstrong B, Williams N, Odim J, Shemesh E, Sweet S, Annunziato R. Posttraumatic stress and medication adherence in pediatric transplant recipients. Am J Transplant 2022; 22:937-946. [PMID: 34837457 PMCID: PMC8897237 DOI: 10.1111/ajt.16896] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/25/2023]
Abstract
Adolescent transplant recipients may encounter a range of potentially traumatic events (PTEs) pre- and posttransplant, yet little is known about the relationship between posttraumatic stress symptoms (PTSS) and medication adherence in this population. In the present study, adolescent recipients and caregivers completed psychosocial questionnaires at enrollment. Outpatient tacrolimus trough level data were collected over 1 year to calculate the Medication Level Variability Index (MLVI), a measure of medication adherence. Nonadherence (MLVI ≥2) was identified in 34.8% of patients, and most (80.7%) reported ≥1 PTE exposure. Levels of PTSS indicating likely posttraumatic stress disorder (PTSD) were endorsed by 9.2% of patients and 43.7% of caregivers. PTSS and MLVI were significantly correlated in the liver subgroup (r = .30, p = .04). Hierarchical multivariable linear regression analyses revealed overall patient PTSS were significantly associated with QoL (p < .001). PTEs are common in adolescent recipients; a minority may meet criteria for PTSD. PTSS screening to identify nonadherence risk requires further investigation and addressing PTSS may improve QoL. Caregivers appear at greater risk for PTSD and may require their own supports. The study was approved by each participating center's Institutional Review Board.
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Affiliation(s)
- Sarah Duncan-Park
- Icahn School of Medicine at Mount Sinai, NY, NY,Fordham University, Bronx, NY
| | | | | | | | | | | | | | - Rachel Annunziato
- Icahn School of Medicine at Mount Sinai, NY, NY,Fordham University, Bronx, NY
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10
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Brown T, Chen S, Ou Z, McDonald N, Bennett-Murphy L, Schneider L, Giles L, Molina K, Cox D, Hoskoppal A, Glotzbach K, Stehlik J, May L. Feasibility of Assessing Adolescent and Young Adult Heart Transplant Recipient Mental Health and Resilience Using Patient-Reported Outcome Measures. J Acad Consult Liaison Psychiatry 2022; 63:153-162. [PMID: 34438097 PMCID: PMC8866525 DOI: 10.1016/j.jaclp.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/05/2021] [Accepted: 08/11/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although adolescents and young adults may be particularly prone to mental health symptoms after heart transplant, screening practices are variable. OBJECTIVE To assess the feasibility of using patient-reported outcome (PRO) measures to assess mental health, functional status, and resiliency in posttransplant adolescents and young adult patients. METHODS Patients transplanted between ages 15 and 25 years at 3 centers completed 6 PRO instruments via web-based platforms: PROMIS instruments for anxiety, depression, satisfaction with social roles, and physical functioning; the Posttraumatic Stress Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, version 5; and the Connor-Davidson Resilience Scale-10. Feasibility (completion, time to completion, and measure missingness) and PRO results were described and compared between patients with congenital heart disease and cardiomyopathy. RESULTS Nineteen patients (median age at transplant 17.7 y [interquartile range 16.3, 19.2 y], 84% male) were enrolled at an average of 3 ± 1.8 years after transplant. Enrollment was 90% among eligible patients. Measure missingness was zero. The average completion time was 12 ± 15 minutes for all instruments. Timely PRO completion was facilitated by in-clinic application. The PRO results indicated that 9 patients (47%) had at least mild posttraumatic stress disorder symptoms (≥11 points on Posttraumatic Stress Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, version 5). Among them, 4 patients had scores >28 suggestive of probable posttraumatic stress disorder. Two (11%) and 6 (32%) patients had anxious and depressive symptoms, respectively. The cardiomyopathy cohort had a higher median Posttraumatic Stress Diagnostic Scale for Diagnostic and Statistical Manual of Mental Disorders, version 5 score than that of the congenital heart disease subgroup (11.0 vs 6.0; P = 0.015). Twelve (63%) had resiliency scores that were lower than the population average. No significant differences were found in PRO results between patients with cardiomyopathy and congenital heart disease apart from the posttraumatic stress disorder assessment. CONCLUSIONS This novel PRO-based approach to psychiatric screening of adolescents and young adult patients after transplant appears feasible for assessing mental health, functional status, and resiliency, with excellent enrollment and completion rates. These instruments characterized the burden of mental health symptoms within this adolescents and young adult heart transplant cohort, with a high prevalence of posttraumatic stress disorder symptoms. Resiliency scores were lower than in a comparison population. Electronically-administered PRO administration could facilitate more consistent mental health screening in this at-risk group.
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Affiliation(s)
- Tyler Brown
- Department of Pediatrics, University of Utah, Salt Lake City, UT.
| | | | - Zhining Ou
- Division of Epidemiology, Internal Medicine, University of Utah, Salt Lake City, UT
| | | | | | | | - Lisa Giles
- Pediatrics, University of Utah, Salt Lake City, UT
| | - Kimberly Molina
- Pediatric Cardiology, University of Utah, Salt Lake City, UT
| | - Daniel Cox
- Pediatric Cardiology, University of Utah, Salt Lake City, UT
| | | | | | - Josef Stehlik
- Cardiovascular Medicine, University of Utah, Salt Lake City, UT
| | - Lindsay May
- Pediatric Cardiology, University of Utah, Salt Lake City, UT
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11
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Satoko I, Oshibuchi H, Tsutsui J, Kobayashi S, Takano K, Sugawara H, Kamba R, Akaho R, Ishida H, Maldonado J, Nishimura K. Psychosocial Assessment of Transplant Candidates: Inter-rater Reliability and Concurrent Validity of the Japanese Version of the Stanford Integrated Psychosocial Assessment for Transplantation. J Acad Consult Liaison Psychiatry 2021; 63:345-353. [PMID: 34863909 DOI: 10.1016/j.jaclp.2021.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 09/19/2021] [Accepted: 10/30/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT) is a comprehensive instrument developed to provide a standardized, objective, and evidence-based psychosocial evaluation of the main pretransplant psychosocial risk factors that may influence transplant outcomes. OBJECTIVE Because established assessment procedures or standardized tools designed to perform pre-solid organ transplant psychosocial evaluation are currently unavailable in Japan, the present study aimed to develop and preliminarily validate the Japanese version of the SIPAT. METHODS First, the Japanese version of the SIPAT was developed using standard forward-back-translation procedures. Then, the Japanese versions of the SIPAT and the Japanese version of Psychosocial Assessment of Candidates for Transplant were retrospectively and blindly applied to 107 transplant cases by 4 independent raters. RESULTS The interrater reliability of the scores obtained with the Japanese version of the SIPAT was excellent (Pearson's correlation coefficient = 0.86). The concurrent validity of the SIPAT to the Psychosocial Assessment of Candidates for Transplant for each examiner was substantial (Spearman's rank correlation coefficient = -0.66). CONCLUSION These findings suggest that the Japanese version of the SIPAT is a promising and reliable instrument. Further research is required to test the predictive validity of the Japanese version of the SIPAT.
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Affiliation(s)
- Ito Satoko
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidehiro Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Department of Child Psychiatry, Kanagawa Children's Medical Center, Yokohama-shi, Kanagawa, Japan.
| | - Junko Tsutsui
- Faculty of Human science Denen-chofu University, Kawasaki city, Japan
| | - Sayaka Kobayashi
- Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Saitama, Japan
| | - Kosuke Takano
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroko Sugawara
- Department of Psychiatry, Kansai Rosai Hospital, Amagasaki, Japan; Department of Psychiatry, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Rumiko Kamba
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, Tokyo, Japan
| | - Jose Maldonado
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
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12
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Kruckenberg KM, Shenai N, Dew MA, Switzer G, Hughes C, DiMartini AF. Transplant-related trauma, personal growth and alcohol use outcomes in a cohort of patients receiving transplants for alcohol associated liver disease. Gen Hosp Psychiatry 2021; 72:73-80. [PMID: 34311144 DOI: 10.1016/j.genhosppsych.2021.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/07/2021] [Accepted: 07/13/2021] [Indexed: 01/26/2023]
Abstract
BACKGROUND Liver transplantation (LT) is stressful experience which can cause psychological trauma but also positive growth. We examined the prevalence of transplant related post-traumatic stress disorder symptoms (PTSD) and post-traumatic growth (PTG) in a cohort of alcohol-associated liver disease (ALD) LT recipients. We also examined whether PTG or PTSD symptoms were associated with post-LT alcohol use. METHODS Cross sectional survey of 51 ALD LT recipients one-year post-LT assessed PTSD symptoms, PTG, stress, self-efficacy, social support, and alcohol use. RESULTS 18% endorsed symptoms of PTSD; 59% endorsed high PTG. PTSD symptoms and PTG were not associated. 18% drank alcohol; 10% returned to health harmful use. Neither PTSD symptoms nor PTG were associated with alcohol use. Less self-efficacy to abstain and thoughts of drinking were associated with alcohol use. CONCLUSIONS A substantial percentage of ALD LT patients had transplant-related PTSD symptoms and high PTG. Alcohol use was not associated with PTSD symptoms or PTG. Lower self-efficacy to abstain from alcohol use may provide a valuable clinical measure to assess risk for post-LT use. Clinical screening for PTSD would be beneficial as effective treatments for PTSD exist. Whether PTG can be facilitated in transplant recipients would be a valuable future line of inquiry.
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Affiliation(s)
| | - Neeta Shenai
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Clinical and Translational Science, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Psychology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Epidemiology and Biostatistics, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Galen Switzer
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Clinical and Translational Science, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Christopher Hughes
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America
| | - Andrea F DiMartini
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Clinical and Translational Science, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, United States of America.
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13
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Wessels-Bakker MJ, van de Graaf EA, Kwakkel-van Erp JM, Heijerman HG, Cahn W, Schappin R. The relation between psychological distress and medication adherence in lung transplant candidates and recipients: A cross-sectional study. J Clin Nurs 2021; 31:716-725. [PMID: 34216066 PMCID: PMC9292052 DOI: 10.1111/jocn.15931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 12/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the prevalence of psychological distress such as anxiety, depression and post-traumatic stress disorder and its associations with medication adherence in lung transplant patients. BACKGROUND Psychological distress after lung transplantation may impact clinical outcomes by associated behaviours such as non-adherence to medication. Evidence about the relation between psychological distress and medication adherence in lung transplant patients is limited and not well explained. DESIGN AND METHODS We conducted a single-centre study with a cross-sectional design in 73 lung transplant candidates and 116 recipients. Questionnaires were the Brief Symptom Inventory, Impact of Event Scale and Basel Assessment of Adherence to Immunosuppressive Medications Scale. The STROBE checklist was monitored. RESULTS In candidates, 39.7% reported (sub)clinical symptoms of depression, in recipients this was 21.6%. We observed suicidal ideation in recipients (8.6%), and candidates (5.5%). The prevalence of (sub)clinical symptoms of anxiety was 38.3% in candidates and 33.7% in recipients. After lung transplantation, 12% of the recipients reported clinical symptoms of PTSD related to the transplantation. Symptoms of anxiety and medication adherence were significantly and positively related in transplant recipients. We found no association between depressive or post-traumatic stress symptoms, and medication adherence. CONCLUSIONS In lung transplant patients, we found a high prevalence of symptoms of depression and anxiety. Recipients had high levels of post-traumatic stress symptoms related to the transplantation. The prevalence of suicidal ideation was unexpectedly high in recipients. After lung transplantation, higher levels of anxiety were related to better medication adherence. We propose that LTX recipients are very anxious to develop dyspnoea and therefore take their medication more conscientiously. RELEVANCE TO CLINICAL PRACTICE The clinical nurse specialist can play a key role in identifying and addressing psychological and behavioural problems. More prospective research on the role of anxiety and dyspnoea in lung transplant recipients is recommended.
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Affiliation(s)
- Marion J Wessels-Bakker
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Eduard A van de Graaf
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Harry G Heijerman
- Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wiepke Cahn
- Department of Mental Health, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renske Schappin
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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14
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Duerinckx N, Smith PJ, Vanhaecke J, De Geest S, Van Cleemput J, Lenaerts S, Van Lommel K, Dobbels F. Depressive symptoms at 1 year after surgery increase the risk of cardiac allograft vasculopathy and mortality in heart transplant recipients: A prospective cohort study. Gen Hosp Psychiatry 2021; 71:20-26. [PMID: 33915443 DOI: 10.1016/j.genhosppsych.2021.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/11/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the impact of depressive symptoms at 1-year post-heart transplant (HTx) on cardiac allograft vasculopathy (CAV) and mortality. METHODS We performed a single-center prospective cohort study of patients 1-year post-HTx consecutively enrolled between January 2001 and September 2015, and followed-up until November 2020. Kaplan-Meier and uni- and multivariate cox proportional hazards models were used to investigate the impact of depressive symptoms (Beck Depression Inventory) on all-cause mortality and clustered CAV events, i.e. time to angiographically detected CAV, revascularizations, retransplantation/CAV-mortality. RESULTS 23.7% (45/190) (median age 53.5 [IQR 19.3], 77% men) had mild to severe depressive symptoms (BDI 10-63). Forty-four patients (23.2%) died during a 10.4 years median follow-up. Depressive symptoms (BDI ≥ 10) increased all-cause mortality risk (HR = 2.52 [1.35-4.71], p = .004), even after adjusting for confounders (HR = 2.95 [1.50-5.80], p = .002). CAV data were available for 156 patients. During a 9.9 years median follow-up, 51 patients (32.7%) developed CAV or revascularization of which 8 received at least a second revascularization, 3 were re-transplanted, and 9 died from CAV-related causes. Analysis showed a significant increased CAV-risk among depressed patients (HR = 2.27 [1.10-4.69], p = .026), even in adjusted models (HR = 2.25 [1.01-4.98, p = .047). CONCLUSION Depressive symptoms at 1-year post-HTx unfavorably impact mortality and CAV, highlighting the need for interventions.
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Affiliation(s)
- Nathalie Duerinckx
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Heart Transplant Program, Department of Cardiovascular Diseases, KU Leuven - University of Leuven, Belgium
| | - Patrick J Smith
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, United States of America
| | - Johan Vanhaecke
- Heart Transplant Program, Department of Cardiovascular Diseases, KU Leuven - University of Leuven, Belgium
| | - Sabina De Geest
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Institute of Nursing Science, Department Public Health, University of Basel, Switzerland
| | - Johan Van Cleemput
- Heart Transplant Program, Department of Cardiovascular Diseases, KU Leuven - University of Leuven, Belgium
| | - Steffi Lenaerts
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Department of Critical Care Medicine, University Hospitals of Leuven, Belgium
| | - Katrien Van Lommel
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Abdominal surgery, University Hospitals of Leuven, Belgium
| | - Fabienne Dobbels
- Academic Centre for Nursing and Midwifery, Department of Public Health and Primary Care, KU Leuven - University of Leuven, Belgium; Institute of Nursing Science, Department Public Health, University of Basel, Switzerland.
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15
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Bürker BS, Malt UF, Gude E, Grov I, Relbo Authen A, Dew MA, Gullestad L. Symptoms of anxiety after heart transplantation and their association with mortality: A secondary analysis. Clin Transplant 2021; 35:e14323. [PMID: 33882158 DOI: 10.1111/ctr.14323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/30/2021] [Accepted: 04/12/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Few studies, with inconclusive results, have examined the association of anxiety with mortality after heart transplantation (HTx). We examined whether anxiety symptoms, measured several years after HTx, are associated with increased mortality during long-term follow-up. METHODS Anxiety symptoms were measured with the anxiety subscale of the Symptom Checklist-90-R (SCL-90-R) in 142 HTx recipients at a mean of 5.7 years (SD: 3.9) after HTx. Anxiety symptoms' impact on mortality during follow-up for up to 18.6 years was examined with Cox proportional hazard models. We accounted for relevant sociodemographic and clinical variables, including depressive symptoms (measured by the depression subscale of the SCL-90-R), in the multivariate analyses. In additional analyses, we explored the combined effect of anxious and depressive symptomatology. RESULTS Anxiety symptoms were not significantly associated with mortality (univariate analysis: HR (95% CI): 1.04 (0.75-1.45); p = .813). Exploration of the combined effect of anxious and depressive symptomatology on mortality rendered non-significant results. Depressive symptoms were independently associated with mortality (multivariate analysis: HR (95% CI): 1.86 (1.07-3.24); p = .028). CONCLUSIONS Depressive symptoms' negative impact on survival after HTx was confirmed, while anxiety symptoms were not significantly associated with mortality during long-term follow-up. Anxiety symptoms' predictive role after HTx requires further study.
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Affiliation(s)
- Britta S Bürker
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Department of Psychiatry, Nordland Hospital Trust Bodø, Bodø, Norway
| | - Ulrik F Malt
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Section for C-L psychiatry and Psychosomatic Medicine, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Einar Gude
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Ingelin Grov
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anne Relbo Authen
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Lars Gullestad
- Department of Cardiology, Oslo University Hospital - Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,KG Jebsen Center for Cardiac Research and Center for Heart Failure Research, University of Oslo, Oslo, Norway
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16
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Cyr S, Guo DX, Marcil MJ, Dupont P, Jobidon L, Benrimoh D, Guertin MC, Brouillette J. Posttraumatic stress disorder prevalence in medical populations: A systematic review and meta-analysis. Gen Hosp Psychiatry 2021; 69:81-93. [PMID: 33582645 DOI: 10.1016/j.genhosppsych.2021.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE PTSD is increasingly recognized following medical traumas although is highly heterogeneous. It is difficult to judge which medical contexts have the most traumatic potential and where to concentrate further research and clinical attention for prevention, early detection and treatment. The objective of this study was to compare PTSD prevalence in different medical populations. METHODS A systematic review of the literature on PTSD following medical traumas was conducted as well as a meta-analysis with final pooled result and 95% confidence intervals presented. A meta-regression was used to investigate the impact of potential effect modifiers (PTSD severity, age, sex, timeline) on study effect size between prevalence studies. RESULTS From 3278 abstracts, the authors extracted 292 studies reporting prevalence. Using clinician-administered reports, the highest 24 month or longer PTSD prevalence was found for intraoperative awareness (18.5% [95% CI=5.1%-36.6%]) and the lowest was found for epilepsy (4.5% [95% CI=0.2%-12.6%]). In the overall effect of the meta-regression, only medical events or procedures emerged as significant (p = 0.006) CONCLUSION: This review provides clinicians with greater awareness of medical contexts most associated with PTSD, which may assist them in the decision to engage in more frequent, earlier screening and referral to mental health services.
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Affiliation(s)
- Samuel Cyr
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - De Xuan Guo
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada
| | - Marie-Joëlle Marcil
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - Patrice Dupont
- Health Sciences Library, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Jobidon
- Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada
| | - David Benrimoh
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Marie-Claude Guertin
- Montreal Health Innovations Coordinating Center, Montreal, Montreal, Quebec, Canada
| | - Judith Brouillette
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada; Department of Psychiatry and Addiction, Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada.
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Liyanage-Don N, Birk J, Cornelius T, Sanchez G, Moise N, Edmondson D, Kronish I. Medications as Traumatic Reminders in Patients With Stroke/Transient Ischemic Attack-Induced Posttraumatic Stress Disorder. Stroke 2020; 52:321-324. [PMID: 33272128 DOI: 10.1161/strokeaha.120.031109] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Posttraumatic stress disorder (PTSD) symptoms are common after stroke/transient ischemic attack (TIA) and have been associated with medication nonadherence, potentially because medications serve as traumatic reminders of the prior stroke/TIA. This study examined associations between stroke/TIA-induced PTSD and aversive cognitions toward preventive medications. METHODS We enrolled a cohort of patients presenting to the emergency department with suspected stroke/TIA. One month posthospitalization, we assessed PTSD symptoms specific to the index stroke/TIA using the PTSD checklist specific and asked patients how often (1) did thinking about your stroke medication make you feel nervous or anxious?; (2) did thinking about your stroke medication make you think about your risk for future strokes?; and (3) did you skip or avoid taking your stroke medication so you would not have to think about your stroke? Logistic regression models tested the association between PTSD symptoms and each aversive cognition, adjusting for age, sex, ethnicity, and depression. RESULTS Among 408 included patients, 11.0% had elevated PTSD symptoms. These patients were more likely to report that thinking about their stroke medication made them feel nervous or anxious (37.8% versus 9.9%, P<0.001) that thinking about their stroke medication made them think about their risk for future stroke/TIA (60.0% versus 24.0%, P<0.001), and that they skipped or avoided their stroke medication to not think about their prior stroke/TIA (11.1% versus 2.2%, P=0.009). In adjusted analyses, higher PTSD checklist specific scores were associated with increased nervousness/anxiety (odds ratio, 1.33 [95% CI, 1.18-1.50], P<0.001) and thoughts of future stroke (odds ratio, 1.27 [95% CI, 1.14-1.41], P<0.001), with a trend toward significance for skipping medications to avoid reminders of stroke (odds ratio, 1.20 [95% CI, 0.99-1.44], P=0.06). CONCLUSIONS Medications may serve as traumatic reminders after stroke/TIA-induced PTSD, potentially leading to medication nonadherence.
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Affiliation(s)
- Nadia Liyanage-Don
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Jeffrey Birk
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Talea Cornelius
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Gabriel Sanchez
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Nathalie Moise
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
| | - Ian Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY
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Chih S, McDonald M, Dipchand A, Kim D, Ducharme A, Kaan A, Abbey S, Toma M, Anderson K, Davey R, Mielniczuk L, Campbell P, Zieroth S, Bourgault C, Badiwala M, Clarke B, Belanger E, Carrier M, Conway J, Doucette K, Giannetti N, Isaac D, MacArthur R, Senechal M. Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement on Heart Transplantation: Patient Eligibility, Selection, and Post-Transplantation Care. Can J Cardiol 2020; 36:335-356. [PMID: 32145863 DOI: 10.1016/j.cjca.2019.12.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 12/17/2022] Open
Abstract
Significant practice-changing developments have occurred in the care of heart transplantation candidates and recipients over the past decade. This Canadian Cardiovascular Society/Canadian Cardiac Transplant Network Position Statement provides evidence-based, expert panel recommendations with values and preferences, and practical tips on: (1) patient selection criteria; (2) selected patient populations; and (3) post transplantation surveillance. The recommendations were developed through systematic review of the literature and using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The evolving areas of importance addressed include transplant recipient age, frailty assessment, pulmonary hypertension evaluation, cannabis use, combined heart and other solid organ transplantation, adult congenital heart disease, cardiac amyloidosis, high sensitization, and post-transplantation management of antibodies to human leukocyte antigen, rejection, cardiac allograft vasculopathy, and long-term noncardiac care. Attention is also given to Canadian-specific management strategies including the prioritization of highly sensitized transplant candidates (status 4S) and heart organ allocation algorithms. The focus topics in this position statement highlight the increased complexity of patients who undergo evaluation for heart transplantation as well as improved patient selection, and advances in post-transplantation management and surveillance that have led to better long-term outcomes for heart transplant recipients.
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Affiliation(s)
- Sharon Chih
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
| | - Michael McDonald
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
| | - Anne Dipchand
- Labatt Family Heart Centre, Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Kim
- University of Alberta, Edmonton, Alberta, Canada
| | - Anique Ducharme
- Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada
| | | | - Susan Abbey
- Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Mustafa Toma
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Kim Anderson
- Halifax Infirmary, Department of Medicine-Cardiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ryan Davey
- University of Western Ontario, London, Ontario, Canada
| | - Lisa Mielniczuk
- University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | | | | | - Christine Bourgault
- Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec, Québec
| | - Mitesh Badiwala
- Peter Munk Cardiac Centre, University Health Network and Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Michel Carrier
- Department of Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jennifer Conway
- Stollery Children's Hospital, University of Alberta, Edmonton, Alberta, Canada
| | | | | | - Debra Isaac
- University of Calgary, Calgary, Alberta, Canada
| | | | - Mario Senechal
- Institut Universitaire de Cardiologie et de Pneumologie de Québec (IUCPQ), Université Laval, Laval, Québec, Canada
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19
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Lupi D, Binda B, Montali F, Natili A, Lancione L, Chiappori D, Parzanese I, Maccarone D, Pisani F. Transplant Patients' Isolation and Social Distancing Because of COVID-19: Analysis of the Resilient Capacities of the Transplant in the Management of the Coronavirus Emergency. Transplant Proc 2020; 52:2626-2630. [PMID: 32553507 PMCID: PMC7260500 DOI: 10.1016/j.transproceed.2020.05.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 05/23/2020] [Accepted: 05/26/2020] [Indexed: 02/02/2023]
Abstract
Background One of the peculiar aspects of the transplant patient’s life is that, in the post-surgery phase, the patient lives in an “isolation” condition, having to pay particular attention to the living environment and preferring a limited social life given that the immunosuppressive treatment entails immunodepression in the patient. With coronavirus disease 2019 (COVID)-19, as in a post-surgery situation, social isolation is being implemented. Materials and Methods The study started on March 17, 2020, and ended on April 24, 2020. Consulting/phone interviews were made. The phone questionnaire, submitted to 71 patients, consisted of a set of 15 questions that investigated structure and psychological resistance. Eight patients have been monitored exclusively for the psychological aspect through a more articulate supporting path. Results In essence, from the overall analysis of the data derived from the study of the positioning of patients based on the stage of renal function, the bands related to the development of psychopathological aspects, and the use of positive personal resources, it emerges that patients in stage V kidney failure are in the first bracket as regards the development of psychopathological aspects (absence of these experiences) and in the third bracket as regards the good use of positive resources to deal with isolation. Therefore, it can be deduced that, although with data that can be expanded, a serious or medium-serious situation from an organic point of view in this socio-health emergency situation is well addressed by the transplanted patient. Conclusion Transplant patients have faced the measure of social distancing adequately and in adherence to the treatment thanks to the phone assistance of all the medical-surgical and psychological team.
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Affiliation(s)
- Diana Lupi
- Centro Regionale Trapianti-Regione Abruzzo-Regione Molise, L'Aquila, Italy.
| | - Barbara Binda
- U.O.C. Chirurgia Generale e dei Trapianti d'Organo, L'Aquila, Italy
| | - Filippo Montali
- Università degli Studi dell'Aquila, Dipartimento di Scienze Cliniche Applicate e Biotecnologiche, L'Aquila, Italy
| | - Andrea Natili
- U.O.C. Chirurgia Generale e dei Trapianti d'Organo, L'Aquila, Italy
| | - Laura Lancione
- U.O.C. Chirurgia Generale e dei Trapianti d'Organo, L'Aquila, Italy
| | - Davide Chiappori
- U.O.C. Chirurgia Generale e dei Trapianti d'Organo, L'Aquila, Italy
| | - Ida Parzanese
- Centro Regionale Trapianti-Regione Abruzzo-Regione Molise, L'Aquila, Italy
| | - Daniela Maccarone
- Centro Regionale Trapianti-Regione Abruzzo-Regione Molise, L'Aquila, Italy
| | - Francesco Pisani
- U.O.C. Chirurgia Generale e dei Trapianti d'Organo, L'Aquila, Italy
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20
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Analysis of Psychopathologic Elements as a Compliance Limitation: Team Work as a Therapeutic Response. Transplant Proc 2020; 52:1577-1580. [PMID: 32439333 DOI: 10.1016/j.transproceed.2020.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/24/2020] [Accepted: 03/12/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The psychological evaluation of the patient, carried out through psychodiagnostic tests, clinical interviews, and a joint work with the medical-surgical team, provided useful information to assess the compliance of the kidney transplant recipient. METHODOLOGY Two hundred and forty-five visits were carried out between September 2018 and May 2019 in the General Surgery and Organ Transplant Department of the San Salvatore Hospital, L'Aquila. The visits consisted of clinical interviews, targeted psychodiagnostic evaluations, graphic-projective tests, and personality and cognitive structure evaluation tests. These assessments were key not only to defining the patient's personality picture but also to offering suitable psychological support to patients on waiting lists for transplantation, during hospitalization, and during follow-up visits from transplantation phases. RESULTS From the analysis of the tests and from the clinical and support interviews, some of the patients presented forms of psycho-emotional immaturity that impaired the predisposition to compliance and ultimately the establishment of the therapeutic alliance. During 8 months, 18 compliance limit cases were observed, 5 patients were sent to mental health centers, and 13 psychological support courses were activated within the Regional Transplant Center-Abruzzo Region Molise Region. No structured psychological support courses were deemed necessary for 9 of these 13 cases, whereas 4 were sent to the mental health centers. CONCLUSIONS By assessing the complexity of each patient from a medical and a psychological point of view and by considering the high number of transplant surgeries currently occurring, it can be noted that compliance to therapy is strongly linked to the reliability of the relationships between patients and caregivers.
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The Predictive Value of Depression in the Years After Heart Transplantation for Mortality During Long-Term Follow-Up. Psychosom Med 2020; 81:513-520. [PMID: 31033937 DOI: 10.1097/psy.0000000000000702] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Current understanding of the prognostic impact of depression on mortality after heart transplantation (HTx) is limited. We examined whether depression after HTx is a predictor of mortality during extended follow-up. Subsequently, we explored whether different symptom dimensions of depression could be identified and whether they were differentially associated with mortality. METHODS Survival analyses were performed in a sample of 141 HTx recipients assessed for depression, measured by self-report of depressive symptoms (Beck Depression Inventory - version 1A [BDI-1A]), at median 5.0 years after HTx, and followed thereafter for survival status for up to 18.6 years. We used uni- and multivariate Cox proportional hazard models to examine the association of clinically significant depression (BDI-1A total score ≥10), as well as the cognitive-affective and the somatic subscales of the BDI-1A (resulting from principal component analysis) with mortality. In the multivariate analyses, we adjusted for relevant sociodemographic and clinical variables. RESULTS Clinically significant depression was a significant predictor of mortality (hazard ratio = 2.088; 95% confidence interval = 1.366-3.192; p = .001). Clinically significant depression also was an independent predictor of mortality in the multivariate analysis (hazard ratio = 1.982; 95% confidence interval = 1.220-3.217; p = .006). The somatic subscale, but not the cognitive-affective subscale, was significantly associated with increased mortality in univariate analyses, whereas neither of the two subscales was an independent predictor of mortality in the multivariate analysis. CONCLUSIONS Depression measured by self-report after HTx is associated with increased mortality during extended follow-up. Clinical utility and predictive validity of specific depression components require further study.
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Jankowska-Polańska B, Świątoniowska-Lonc N, Sławuta A, Krówczyńska D, Dudek K, Mazur G. Patient-Reported Compliance in older age patients with chronic heart failure. PLoS One 2020; 15:e0231076. [PMID: 32298283 PMCID: PMC7161980 DOI: 10.1371/journal.pone.0231076] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 03/15/2020] [Indexed: 01/14/2023] Open
Abstract
METHODS AND RESULTS 475 patients (including 222 women), mean age 69.7±7.7, with HF, hospitalized at University Hospital between January and December 2018 were included in the study. The patients were selected by a physician specializing in cardiology. A cardiac nurse assessed the non-pharmacological level of compliance using the Revised Heart Failure Compliance Questionnaire (RHFCQ). The socio-clinical data were obtained from medical records. The majority of the study group were patients in NYHA II (62.4%) and NYHA III (28.3%), the mean duration of the disease was 6.2±4.9 years, and the mean ejection fraction of the left ventricle (EF) was 48.6±12.6. The average level of compliance in the study group measured on a scale from 0 to 4 points was: median = 2.7, IQR [2.32; 3.25]. Only 6.9% of the respondents adhere to recommendations totally (all dimensions of RHFCQ). In univariate analysis, predictors negatively affecting compliance were: female gender (rho = -0.325), age below 65 years (rho = -0.014)), loneliness (rho = -0.559), number of hospitalizations (rho = -0.242), higher stage of NYHA (rho = -1.612), co-morbidities (rho = -0.729), re-hospitalizations (rho = -0.729), beta-blockers treatment (rho = -1.612) and diuretics treatment (rho = -0.276). Factors positively affecting compliance were: EF≥45% (rho = 0.020) and treatment with ACEI/ARB (rho = 0.34), whereas compliance was negatively affected by-EF<45% (β = 0.009). Independent predictors influencing the level of compliance were: loneliness (β = -1.816), number of hospitalizations (β = -0.117), NYHA III and IV and number of co-morbidities (β = -0.676). CONCLUSIONS Patients with HF do not adhere to therapeutic recommendations. The lowest compliance levels were found for exercise and daily weighing, and the highest for follow-up appointment-keeping and medication. Loneliness and age are the strongest predictors which influence the level of compliance.
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Affiliation(s)
- Beata Jankowska-Polańska
- Department of Clinical Nursing, Faculty of Health Science, Wroclaw Medical University, Wroclaw, Poland
- * E-mail:
| | | | - Agnieszka Sławuta
- Department of Internal Diseases, Occupational Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Dorota Krówczyńska
- Medical University of Warsaw, Department of Clinical Nursing, Warsaw, Poland
| | - Krzysztof Dudek
- Faculty of Mechanical Engineering, Technical University of Wroclaw, Wroclaw, Poland
| | - Grzegorz Mazur
- Department of Internal Diseases, Occupational Medicine, Hypertension and Clinical Oncology, Wroclaw Medical University, Wroclaw, Poland
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Niazi SK, Spaulding A, Vargas E, Schneekloth T, Crook J, Rummans T, Taner CB. Mental health and chemical dependency services at US transplant centers. Am J Transplant 2020; 20:1152-1161. [PMID: 31612625 DOI: 10.1111/ajt.15659] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/04/2019] [Accepted: 10/07/2019] [Indexed: 01/25/2023]
Abstract
The purpose of this study was to assess the availability of mental health (MH) and chemical dependency (CD) services at US transplant centers, because appropriate psychosocial assessment and care is associated with better transplant outcomes. We used the 2017-2018 American Hospital Association survey, Area Health Resource File, and Centers for Medicare & Medicaid Services Hospital Compare databases to quantify availability of services and examined associations of hospital- and health services area-level characteristics with odds of offering services with generalized linear mixed models. We found that 15% of transplant centers did not offer MH services and 62% did not offer CD services. Hospitals were more likely to offer MH services if they were larger (OR [95% CI]: 1.03 [1.01, 1.06]) and had a lower rate of uninsured patients in the health services area (OR [95% CI]: 0.89 [0.80, 0.99]) and were more likely to offer CD services if they were larger (OR [95% CI]: 1.02 [1.01, 1.03]) or were members of a system (OR [95% CI]: 2.31 [1.26, 4.24]). Additional research is needed to understand whether lack of MH or CD services at transplant centers affects patients' ability to access comprehensive psychosocial care and whether this affects patient outcomes.
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Affiliation(s)
- Shehzad K Niazi
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.,Department of Transplantation, Mayo Clinic, Jacksonville, Florida
| | - Aaron Spaulding
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.,Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Emily Vargas
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Jacksonville, Florida.,Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Terry Schneekloth
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - Julia Crook
- Department of Health Services Research, Mayo Clinic, Jacksonville, Florida
| | - Teresa Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, Florida.,Department of Psychiatry & Psychology, Mayo Clinic, Rochester, Minnesota
| | - C Burcin Taner
- Department of Transplantation, Mayo Clinic, Jacksonville, Florida
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24
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Bottesi G, Granziol U, Forza G, Volpe B, Feltrin A, Battermann F, Cavalli C, Cillo U, Gerosa G, Fraiese A, Rea F, Loy M, Maiorano D, Rizzi I, Leandro G, Ferraro C, Biasi C, Donato D, Vidotto G, Maldonado JR. The Psychosocial Assessment of Transplant Candidates: Inter-Rater Reliability and Predictive Value of the Italian Stanford Integrated Psychosocial Assessment for Transplantation (SIPAT). PSYCHOSOMATICS 2020; 61:127-134. [DOI: 10.1016/j.psym.2019.11.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/25/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
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25
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Tully PJ, Cosh SM. Post-traumatic Stress Disorder in Heart Failure Patients: A Test of the Cardiac Disease-induced PTSD Hypothesis. CURRENT PSYCHIATRY RESEARCH AND REVIEWS 2020. [DOI: 10.2174/2666082215666191113121558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background:Post-traumatic stress disorder (PTSD) is prevalent in approximately 12% of patients with cardiovascular disease (CVD) and such patients are at risk of further CVD morbidity and mortality. It is unknown whether CVD patients with cardiac and non-cardiac traumatic events leading to PTSD differ in medical comorbidities and psychiatric vulnerabilities. Our objective was to compare heart failure (HF) patients with cardiac and non-cardiac PTSD.Method:A population of HF patients from 3 hospitals underwent a two-step depression and anxiety screening process to identify potential mental health treatment needs. The post-traumatic stress disorder module of the Structured Clinical Interview for DSM-IV Axis-I disorders was used to classify trauma(s) exposure, and other disorders. The patients with PTSD were sub-divided by cardiac related traumas (e.g. myocardial infarction, sudden cardiac arrest) and non-cardiac related traumas (e.g. sexual abuse, interpersonal violence).Results:10 patients met criteria for non-cardiac trauma and 18 patients met criteria for cardiacinduced trauma. There were no significant differences in HF aetiology or severity nor cardiac comorbidities. Time since PTSD, onset was significantly longer for those with non-cardiac PTSD. Among psychiatric comorbidities, alcohol and substance abuse disorders, as well as depression were more prevalent in patients with non-cardiac PTSD.Conclusion:Cardiac related PTSD was associated with less alcohol and substance abuse disorders, and depression by comparison to their non-cardiac induced PTSD counterparts. Ongoing research is required to establish if cardiac-induced PTSD truly reflects a unique subtype of PTSD, and whether there are different treatment needs and therapeutic approaches for this subtype.
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Affiliation(s)
- Phillip J. Tully
- Freemasons Foundation Centre for Men’s Health, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Suzanne M. Cosh
- School of Psychology, University of New England, Armidale, Australia
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26
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Hou J, Fu J, Meng S, Jiang T, Guo C, Wu H, Su B, Zhang T. Posttraumatic Stress Disorder and Nonadherence to Treatment in People Living With HIV: A Systematic Review and Meta-analysis. Front Psychiatry 2020; 11:834. [PMID: 32973579 PMCID: PMC7466667 DOI: 10.3389/fpsyt.2020.00834] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/31/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Posttraumatic stress disorder (PTSD) is a commonly reported and serious complication among people living with HIV (PLWH). PTSD may significantly increase unintentional non-adherence to antiretroviral therapy. In this systematic review and meta-analysis, we aimed to pool the observational studies exploring the association between PTSD and medication adherence among PLWH. METHODS Comprehensive searches were conducted in PubMed/Medline, Web of Science, PsycINFO, Google Scholar, and ProQuest to identify relevant articles and dissertations. A random effects meta-analysis with inverse variance weighting was used to summarize the odds ratio (OR) across studies. Meta-regression and subgroup analyses were also carried out to assess the moderation effects for potential factors. RESULTS By synthesizing 12 studies comprising 2489 participants, the pooled odd ratio of non-adherence to antiretroviral therapy was 1.19 (95% confidential interval (CI), 1.03-1.37, p = 0.02). No significant publication bias was detected by Egger's test (Intercept = 0.842, p = 0.284). Factors moderating the association were mean age of participants, depression adjustment, and depression (all p < 0.05). CONCLUSIONS This meta-analysis supports that PTSD is related to adherence in PLWH. The hypothesized mechanisms (avoidant behavior and cognitive impairment) underlying this association need further investigation. Overall, this study highlights that clinicians should thoughtfully integrate timely mental health intervention into routine care.
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Affiliation(s)
- Jianhua Hou
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Jiangning Fu
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Siyan Meng
- School of Public Health, Yale University, New Haven, CT, United States
| | - Taiyi Jiang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Caiping Guo
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Hao Wu
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Bin Su
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
| | - Tong Zhang
- Center for Infectious Diseases, Beijing Youan Hospital, Capital Medical University, Beijing, China.,Beijing Key Laboratory for HIV/AIDS Research, Beijing, China
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27
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Chernyak Y, Teh L. Medically Induced Exacerbation of PTSD Following Lung Transplantation: A Case Series. J Clin Psychol Med Settings 2019; 27:305-309. [DOI: 10.1007/s10880-019-09691-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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28
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Bachem R, Baumann J, Köllner V. ICD-11 Adjustment Disorder among Organ Transplant Patients and Their Relatives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16173030. [PMID: 31438589 PMCID: PMC6747135 DOI: 10.3390/ijerph16173030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/14/2019] [Accepted: 08/17/2019] [Indexed: 01/06/2023]
Abstract
Adjustment disorder (AD) is one of the most frequent mental health conditions after stressful life experiences in the medical setting. The diagnosis has been conceptually redefined in International Classification of Diseases (ICD-11) and now includes specific symptoms of preoccupations and failure to adapt. The current study assesses the prevalence of self-reported ICD-11 AD among organ transplantation patients and their relatives, explores the association of patients’ demographic-, transplant-, and health-related characteristics and ICD-11 AD symptoms, and evaluates the role of social support in the post- transplant context. A total of N = 140 patient-relative dyads were examined cross-sectionally. Hierarchical linear regression analyses were conducted to explore potential predictive factors of AD. The results revealed an AD prevalence of 10.7% among patients and 16.4% among relatives at an average of 13.5 years after the transplantation. The time that had passed since the transplantation was unrelated to AD symptom severity. Women tended to be at a higher risk in both groups. Somatic issues were predictive for AD only among patients and social support was predictive mainly among relatives. The results suggest that ICD-11 AD is a relevant diagnosis after organ transplantations for patients and relatives and its specific symptom clusters may provide important information for developing intervention strategies.
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Affiliation(s)
- Rahel Bachem
- I-Core Research Center for Mass Trauma, Tel Aviv University, Chaim Levanon 30, Tel Aviv 6997801, Israel.
- Bob Shapell School of Social Work, Tel-Aviv University, Chaim Levanon 30, Tel Aviv 6997801, Israel.
| | - Jan Baumann
- Saarland University Medical Center, Faculty of Medicine, University of Saarland, 66421 Homburg/Saar, Germany
| | - Volker Köllner
- Department of Psychosomatic Medicine, Rehabilitation Center Seehof, Federal German Pension Agency, 14513 Teltow, Germany
- Psychosomatic Rehabilitation Research Group, Department of Psychosomatic Medicine, Center for Internal Medicine and Dermatology Charité-Universitätsmedizin Berlin, 10098 Berlin, Germany
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29
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Siwakoti A, Potukuchi PK, Thomas F, Gaipov A, Talwar M, Balaraman V, Cseprekal O, Yazawa M, Streja E, Eason JD, Kalantar-Zadeh K, Kovesdy CP, Molnar MZ. History of posttraumatic stress disorder and outcomes after kidney transplantation. Am J Transplant 2019; 19:2294-2305. [PMID: 30672107 PMCID: PMC6650381 DOI: 10.1111/ajt.15268] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 01/15/2019] [Accepted: 01/16/2019] [Indexed: 01/25/2023]
Abstract
A history of posttraumatic stress disorder (PTSD), if uncontrolled, represents a contraindication for kidney transplantation. However, no previous large study has assessed the association between pretransplant history of PTSD and posttransplantation outcomes. We examined 4479 US veterans who had undergone transplantation. The diagnosis of history of PTSD was based on a validated algorithm. Measured covariates were used to create a matched cohort (n = 560). Associations between pretransplant PTSD and death with functioning graft, all-cause death, and graft loss were examined in survival models. Posttransplant medication nonadherence was assessed using proportion of days covered (PDC). From among 4479 veterans, 282 (6.3%) had a history of PTSD. The mean age ± standard deviation (SD) of the cohort at baseline was 61 ± 11 years, 91% were male, and 66% and 28% of patients were white and African American, respectively. Compared to patients without a history of PTSD, patients with a history of PTSD had a similar risk of death with a functioning graft (subhazard ratio [SHR] 0.97, 95% confidence interval [CI] 0.61-1.54), all-cause death (1.05, 0.69-1.58), and graft loss (1.09, 0.53-2.26). Moreover, there was no difference in immunosuppressive drug PDC in patients with and without a history of PTSD (PDC: 98 ± 4% vs 99 ± 3%, P = .733 for tacrolimus; PDC: 99 ± 4% vs 98 ± 7%, P = .369 for mycophenolic acid). A history of PTSD in US veterans with end-stage renal disease should not on its own preclude a veteran from being considered for transplantation.
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Affiliation(s)
- Ashmita Siwakoti
- Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Praveen K. Potukuchi
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee,IHOP, College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Abduzhappar Gaipov
- Department of Medicine, Nazarbayev University School of Medicine, Astana, Kazakhstan
| | - Manish Talwar
- Methodist University Hospital Transplant Institute, Memphis, Tennessee,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Vasanthi Balaraman
- Methodist University Hospital Transplant Institute, Memphis, Tennessee,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Orsolya Cseprekal
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
| | - Masahiko Yazawa
- Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Elani Streja
- Division of Nephrology, University of California, Irvine, California
| | - James D. Eason
- Methodist University Hospital Transplant Institute, Memphis, Tennessee,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | | | - Csaba P. Kovesdy
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee,Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, Tennessee
| | - Miklos Z. Molnar
- Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee,Methodist University Hospital Transplant Institute, Memphis, Tennessee,Division of Transplant Surgery, Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee,Department of Transplantation and Surgery, Semmelweis University, Budapest, Hungary
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30
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Bui QM, Allen LA, LeMond L, Brambatti M, Adler E. Psychosocial Evaluation of Candidates for Heart Transplant and Ventricular Assist Devices: Beyond the Current Consensus. Circ Heart Fail 2019; 12:e006058. [DOI: 10.1161/circheartfailure.119.006058] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Advanced heart failure therapies, including heart transplantation and durable mechanical circulatory support, are available to a limited number of patients because of the scarcity of donors, expense, and large burden of care. The importance of psychological and social determinants of health, including cognitive status, health literacy, psychopathology, social support, medical adherence, and substance abuse, are emphasized in advanced heart failure and further amplified in the context of mechanical circulatory support and heart transplantation. The psychosocial assessment of advanced heart failure therapy candidates remains largely subjective, requiring a multidisciplinary evaluation, which may include psychiatrists, social workers, case managers, financial coordinators, pharmacists, and clinicians. Objective tools—including the Stanford Integrated Psychosocial Assessment for Transplantation, Psychosocial Assessment of Candidates for Transplantation, and Transplant Evaluation Rating Scale—were developed and validated in limited populations to help standardize the evaluation process. Small, retrospective studies have inconsistently shown that these tools may predict clinical outcomes in the transplant population, with higher-risk scores associated with readmissions, rejection episodes, and infections. However, it has been more difficult to show that these tools can predict mortality, and their applicability to the mechanical circulatory support population is less studied. The International Society for Heart and Lung Transplantation released a consensus statement in 2018 to promote consistency of psychosocial evaluation across advanced heart failure programs, but it lacks specific recommendations given the current state of evidence. This state-of-the-art review expands on the current consensus by critically reviewing current studies supporting available objective assessment tools, proposing a psychosocial evaluation framework that uses a multidisciplinary approach and offering future directions for research.
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Affiliation(s)
- Quan M. Bui
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Larry A. Allen
- Division of Cardiology, Department of Medicine, University of Colorado, Aurora (L.A.A.)
| | - Lisa LeMond
- Department of Cardiology, Mayo Clinic Arizona, Phoenix (L.L.)
| | - Michela Brambatti
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
| | - Eric Adler
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego (Q.M.B., M.B., E.A.)
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31
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Kahl KG, Eckermann G, Frieling H, Hillemacher T. Psychopharmacology in transplantation medicine. Prog Neuropsychopharmacol Biol Psychiatry 2019; 88:74-85. [PMID: 30018020 DOI: 10.1016/j.pnpbp.2018.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 06/07/2018] [Accepted: 07/05/2018] [Indexed: 12/18/2022]
Abstract
Organ transplantation has become a well-established treatment option in patients with end-stage organ diseases. Although quality of life has markedly improved, psychiatric disorders before and after transplantation are more frequent compared to the general population. Psychopharmacological treatment is recommended for almost all mental disorders according to current guidelines, but may pose particular problems in organ transplant patients. Changes in the metabolism and elimination of drugs during organ insufficiency, drug interactions, and overlapping side effects between psychopharmacological and immunosuppressive drugs are challenging problems in clinical management. Furthermore, questions frequently arise concerning the use of psychopharmacological treatment options for sleeping and anxiety disorders. This article reviews psychopharmacology in organ transplant patients, with particular attention to frequent psychiatric disorders observed in the disease course of end-stage organ diseases.
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Affiliation(s)
- Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany; Section Polypharmacy, Working Group on Neuropsychopharmacology and Pharmacopsychiatry (AGNP), Germany.
| | - Gabriel Eckermann
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany; Section Polypharmacy, Working Group on Neuropsychopharmacology and Pharmacopsychiatry (AGNP), Germany
| | - Helge Frieling
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany
| | - Thomas Hillemacher
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Medical School, Hannover, Germany; Department of Psychiatry and Psychotherapy, Klinikum Nürnberg, Universitätsklinik der Paracelsus Medizinischen Privatuniversität, Germany
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32
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW Recommendations for the Psychosocial Evaluation of Adult Cardiothoracic Transplant Candidates and Candidates for Long-term Mechanical Circulatory Support. PSYCHOSOMATICS 2018; 59:415-440. [DOI: 10.1016/j.psym.2018.04.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/09/2018] [Indexed: 12/28/2022]
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33
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Wasson LT, Shaffer JA, Edmondson D, Bring R, Brondolo E, Falzon L, Kronish IM, Kronish IM. Posttraumatic stress disorder and nonadherence to medications prescribed for chronic medical conditions: A meta-analysis. J Psychiatr Res 2018; 102:102-109. [PMID: 29631190 PMCID: PMC6124486 DOI: 10.1016/j.jpsychires.2018.02.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/31/2018] [Accepted: 02/15/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with posttraumatic stress disorder (PTSD) are at increased risk for adverse consequences from comorbid medical conditions. Nonadherence to medications prescribed to treat those comorbid conditions may help explain this increased risk. We sought to determine the association between PTSD and medication nonadherence and whether it varied according to the type of event inducing the PTSD. METHODS Prospective observational cohort or cross-sectional studies relating PTSD and nonadherence among adults prescribed medications for a chronic medical illness were identified by searching MEDLINE, EMBASE, PsycINFO, the Cochrane Library, CINAHL, SCOPUS, and the PILOTS Database and by hand-searching bibliographies from selected articles. Individual estimates of odds ratios were pooled using random effects meta-analysis with inverse variance weighting. Articles were pooled separately according to whether PTSD was induced by a medical versus non-medical event. OUTCOMES Sixteen articles comprising 4483 patients met eligibility criteria. The pooled effect size of the risk of PTSD to medication nonadherence was OR 1.22 (95% CI, 1.06-1.41). Among the 6 studies of medical event-induced PTSD, the OR was 2.08 (95% CI, 1.03-4.18); p = 0.04. Among the 8 studies in which PTSD was not induced by a medical event, the OR was 1.10 (95% CI, 0.99-1.24); p = 0.09. INTERPRETATION Patients with PTSD were more likely to be nonadherent to medications prescribed for chronic medical conditions - an association that may exist specifically when PTSD was induced by a medical event. Medications may serve as aversive reminders among survivors of acute medical events, magnifying avoidance behaviors characteristic of PTSD. FUNDING NHLBI.
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Affiliation(s)
- Lauren Taggart Wasson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032,Corresponding Author: Lauren Taggart Wasson, MD MPH; Columbia University Medical Center, 622 West 168 Street, PH9-319, New York, NY 10032; Phone: 212-304-5215; Fax 212-342-3431;
| | - Jonathan A. Shaffer
- Department of Psychology, College of Liberal Arts and Sciences University of Colorado at Denver, PO Box 173364, Denver, CO 80217
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Rachel Bring
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Elena Brondolo
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Louise Falzon
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 W. 168 Street, New York, NY 10032
| | - Ian M Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY, United States
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34
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Schneekloth TD, Hitschfeld MJ, Jowsey-Gregoire SG, Petterson TM, Dunlay SM, Niazi SK, Vasquez AR, Rummans TA. Psychosocial Risk Predicts New Episode Depression After Heart Transplant. PSYCHOSOMATICS 2018; 60:47-55. [PMID: 30064730 DOI: 10.1016/j.psym.2018.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 11/18/2022]
Abstract
BACKGROUND Psychosocial assessment is an essential component of the pretransplant evaluation. Many individuals have significant psychosocial problems, and they are either denied for transplantation or deferred from listing and transplant until the psychosocial issues are addressed. OBJECTIVE The primary aim of this study was to evaluate the outcomes of patients who initially had significant psychosocial problems, but who addressed them and received a heart transplant. METHODS This retrospective study included heart transplant recipients from 1/1/2000 to 12/31/2012. Those with initial Psychosocial Assessment of Candidates for Transplantation (PACT) scale score <2 were compared with those whose initial score was ≥2 for the variables new onset depression and anxiety, length of stay, rejection, and survival using logistic and linear regression and Cox proportional hazards modeling. RESULTS Of 164 heart recipients with pretransplant PACT scores, 46 (28%) were female, 154 (94%) were white, and the mean age was 52.7 years. Only 11 (7%) received an initial PACT score <2; these candidates underwent heart transplantation after their scores increased to ≥2. Initial PACT <2 increased the odds of new depression by 11-fold (p = 0.002), but was not associated with differences in survival, posttransplant length of stay, the occurrence of treated episodes of rejection or new anxiety (p ≥ 0.20 for all). CONCLUSION Among heart recipients, initially high pretransplant psychosocial risk, as assessed by PACT, was associated with posttransplant new episode depression. However, after addressing the primary psychosocial issues before transplant, posttransplant length of stay, organ rejection, and survival were the same as those without prior psychosocial concerns.
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Affiliation(s)
- Terry D Schneekloth
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN.
| | | | - Sheila G Jowsey-Gregoire
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN; William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN
| | | | - Shannon M Dunlay
- William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN; Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Shehzad K Niazi
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL
| | - Adriana R Vasquez
- Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL
| | - Teresa A Rummans
- Department of Psychiatry & Psychology, Mayo Clinic, Rochester, MN; Department of Psychiatry & Psychology, Mayo Clinic, Jacksonville, FL
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Dew MA, DiMartini AF, Dobbels F, Grady KL, Jowsey-Gregoire SG, Kaan A, Kendall K, Young QR, Abbey SE, Butt Z, Crone CC, De Geest S, Doligalski CT, Kugler C, McDonald L, Ohler L, Painter L, Petty MG, Robson D, Schlöglhofer T, Schneekloth TD, Singer JP, Smith PJ, Spaderna H, Teuteberg JJ, Yusen RD, Zimbrean PC. The 2018 ISHLT/APM/AST/ICCAC/STSW recommendations for the psychosocial evaluation of adult cardiothoracic transplant candidates and candidates for long-term mechanical circulatory support. J Heart Lung Transplant 2018; 37:803-823. [PMID: 29709440 DOI: 10.1016/j.healun.2018.03.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
The psychosocial evaluation is well-recognized as an important component of the multifaceted assessment process to determine candidacy for heart transplantation, lung transplantation, and long-term mechanical circulatory support (MCS). However, there is no consensus-based set of recommendations for either the full range of psychosocial domains to be assessed during the evaluation, or the set of processes and procedures to be used to conduct the evaluation, report its findings, and monitor patients' receipt of and response to interventions for any problems identified. This document provides recommendations on both evaluation content and process. It represents a collaborative effort of the International Society for Heart and Lung Transplantation (ISHLT) and the Academy of Psychosomatic Medicine, American Society of Transplantation, International Consortium of Circulatory Assist Clinicians, and Society for Transplant Social Workers. The Nursing, Health Science and Allied Health Council of the ISHLT organized a Writing Committee composed of international experts representing the ISHLT and the collaborating societies. This Committee synthesized expert opinion and conducted a comprehensive literature review to support the psychosocial evaluation content and process recommendations that were developed. The recommendations are intended to dovetail with current ISHLT guidelines and consensus statements for the selection of candidates for cardiothoracic transplantation and MCS implantation. Moreover, the recommendations are designed to promote consistency across programs in the performance of the psychosocial evaluation by proposing a core set of content domains and processes that can be expanded as needed to meet programs' unique needs and goals.
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Affiliation(s)
- Mary Amanda Dew
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA.
| | - Andrea F DiMartini
- University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, Pennsylvania, USA
| | | | - Kathleen L Grady
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Annemarie Kaan
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | | | | | - Susan E Abbey
- University of Toronto and University Health Network, Toronto, Ontario, Canada
| | - Zeeshan Butt
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Sabina De Geest
- Katholieke Universiteit Leuven, Leuven, Belgium; University of Basel, Basel, Switzerland
| | | | | | - Laurie McDonald
- University of North Carolina, Chapel Hill, North Carolina, USA
| | - Linda Ohler
- George Washington University, Washington, DC, USA
| | - Liz Painter
- Auckland City Hospital, Auckland, New Zealand
| | | | - Desiree Robson
- St. Vincent's Hospital, Sydney, New South Wales, Australia
| | | | | | - Jonathan P Singer
- University of California at San Francisco, San Francisco, California, USA
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Husain SA, Edmondson D, Kautz M, Umland R, Kronish IM. Posttraumatic stress disorder due to acute cardiac events and aversive cognitions towards cardiovascular medications. J Behav Med 2017; 41:261-268. [PMID: 29204908 DOI: 10.1007/s10865-017-9906-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 11/24/2017] [Indexed: 10/18/2022]
Abstract
Posttraumatic stress disorder (PTSD) after acute medical events is associated with medication nonadherence. The mechanisms of PTSD-related nonadherence are poorly understood. We tested whether patients with elevated PTSD symptoms induced by suspected acute coronary syndrome (ACS) were more likely to have aversive cognitions towards cardiovascular medications. We enrolled a consecutive cohort of patients who presented to the emergency department with suspected ACS. One month after discharge, ACS-induced PTSD symptoms were assessed using the PTSD Checklist (PCL-S), and patients were asked "how often did" (1) "you miss your heart medication because you did not want to be reminded about your heart problem"; (2) "thinking about your heart medication make you feel nervous or anxious"; and (3) "thinking about your heart medication make you think about your risk for future heart problems." Logistic regression was used to determine the association between elevated PTSD symptoms and each aversive cognition, adjusting for age, sex, race, ethnicity, education, depression, and ACS status. Of 424 patients included, 15.8% had elevated PTSD symptoms (PCL-S ≥ 34). In adjusted analyses, higher PCL-S scores were associated with missing medications to avoid reminders of heart disease (OR 1.22 per 5-point PCL-S increase, 95%CI 1.07-1.40), as well as anxiety (OR 1.34, 95%CI 1.19-1.51) and thoughts of future risk (OR 1.19, 95%CI 1.08-1.32) when thinking about cardiovascular medications. We concluded that patients with elevated PTSD symptoms following suspected ACS were more likely to report aversive cognitions about their cardiovascular medications, suggesting that medications can act as traumatic reminders of the cardiac event and ongoing risk in this group.
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Affiliation(s)
- S Ali Husain
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Donald Edmondson
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA
| | - Marin Kautz
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA
| | - Redeana Umland
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA
| | - Ian M Kronish
- Department of Medicine, Center for Behavioral Cardiovascular Health, Columbia University Medical Center, 622 West 168th Street, PH9-311, New York, NY, 10032, USA.
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38
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Lundgren S, Poon CYM, Selim A, Lowes BD, Zolty R, Burdorf A, Potashnik-Peled Y, Moulton MJ, Um JY, Raichlin E. Depression and anxiety in patients undergoing left ventricular assist device implantation. Int J Artif Organs 2017; 41:0. [PMID: 29099540 DOI: 10.5301/ijao.5000650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/15/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Depression and anxiety are associated with a worse prognosis in heart failure patients. The aim of this study was to identify the prevalence of depression and anxiety in left ventricular assist device (LVAD) candidates and assess their effect on post-LVAD outcomes. METHODS Based on the pre-LVAD psychological assessment, the total cohort of 246 patients were divided into 4 groups: 1) no depression or anxiety (NDep&Anx group, n = 138); 2) isolated depression (Dep group, n = 42); 3) isolated anxiety (Anx group, n = 32), and 4) combined depression and anxiety (Dep&Anx group, n = 34). RESULTS The Dep&Anx group was associated with higher prevalence of female gender (p = 0.03), higher body mass index (p = 0.03), elevated E/E' (p = 0.003), and increased Model For End-Stage Liver Disease (MELD) XI score (p = 0.04) prior to LVAD as compared to the other 3 subgroups. The prevalence of other major psychiatric disorders (p = 0.03) and narcotic dependence (p = 0.004) was higher in the Dep&Anx group. Post-LVAD implantation, heart rate and filling pressures were elevated and readmission rate was higher (p = 0.001) in the Dep&Anx group. There was no difference in survival between the groups (p = 0.40, Log-Rank test). CONCLUSIONS Pre-existing anxiety and depression was associated with worse HF pre- and post-LVAD implantation and higher readmissions rate after LVAD implantation.
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Affiliation(s)
- Scott Lundgren
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | | | - Ahmed Selim
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | - Brian D Lowes
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | - Ronald Zolty
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | - Adam Burdorf
- Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA
| | - Yael Potashnik-Peled
- Sheba Medical Center Heart Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv - Israel
| | - Michael J Moulton
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE - USA
| | - John Y Um
- Department of Cardiothoracic Surgery, University of Nebraska Medical Center, Omaha, NE - USA
| | - Eugenia Raichlin
- Department of Cardiology, Loyola University Medical Center, Maywood, IL - USA
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Lang EV, Viegas J, Bleeker C, Bruhn J, Geert-Jan van G. Helping Children Cope with Medical Tests and Interventions. JOURNAL OF RADIOLOGY NURSING 2017; 36:44-50. [PMID: 28943814 DOI: 10.1016/j.jradnu.2016.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Medical procedures and tests become a challenge when anxiety and pain make it difficult for the patient to cooperate or remain still when needed. Fortunately a short intervention with hypnoidal language at the onset of a procedure induces a positive and sustained change in the way pain and anxiety are processed. While anesthesia may appear to be a simple solution to eliminate pain, the adverse effects of pre-anesthesia anxiety on postoperative behavior and recovery are often not fully appreciated. This paper discusses options for self-hypnotic relaxation that are applicable to interactions with children. The high suggestibility of children makes it relatively easy to engage them in make-believe scenarios. Avoidance of negative suggestions is key in avoiding nocebo effects that may be difficult to overcome later. Once a child is immersed in his or her preferred scenario or hobby/activity of choice, environmental and procedural stimuli can be easily integrated in the imagery. Ego-strengthening metaphors that tie in features of strength, confidence, or resilience are particularly empowering. Even when children are fully under general anesthesia they may still have recall of what is said in the room and therefore caution in word choice should be maintained.
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Affiliation(s)
| | - Jacqueline Viegas
- Cardiac Diagnostic & Interventional Unit, Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Chris Bleeker
- Department of Anesthesia, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Jörgen Bruhn
- Department of Anesthesia, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
| | - Geffen Geert-Jan van
- Department of Anesthesia, Radboud University Medical Center Nijmegen, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, Netherlands
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40
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Evaluation of the SIPAT instrument to assess psychosocial risk in heart transplant candidates: A retrospective single center study. Heart Lung 2017; 46:273-279. [DOI: 10.1016/j.hrtlng.2017.04.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 03/31/2017] [Accepted: 04/10/2017] [Indexed: 01/15/2023]
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41
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Vilchinsky N, Ginzburg K, Fait K, Foa EB. Cardiac-disease-induced PTSD (CDI-PTSD): A systematic review. Clin Psychol Rev 2017; 55:92-106. [DOI: 10.1016/j.cpr.2017.04.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/18/2017] [Accepted: 04/23/2017] [Indexed: 11/25/2022]
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42
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Belaiche S, Décaudin B, Dharancy S, Noel C, Odou P, Hazzan M. Factors relevant to medication non-adherence in kidney transplant: a systematic review. Int J Clin Pharm 2017; 39:582-593. [PMID: 28374343 DOI: 10.1007/s11096-017-0436-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 02/06/2017] [Indexed: 01/14/2023]
Abstract
Background Medication non-adherence is a major issue after transplant that can lead to misdiagnosis, rejection, poor health affecting quality of life, graft loss or death. Several estimations of adherence and related factors have previously been described but conclusions leave doubt as to the most accurate assessment method. Aim of the review To identify the factors most relevant to medication non-adherence in kidney transplant in current clinical practice. Method This systematic review is registered in the PROSPERO data base and follows the Prisma checklist. Articles in English in three databases from January 2009 to December 2014 were analysed. A synthesis was made to target adherence assessment methods, their prevalence and significance. Results Thirty-seven studies were analysed rates of non-adherence fluctuating from 1.6 to 96%. Assessment methods varied from one study to another, although self-reports were mainly used. It appears that youth (≤50 years old), male, low social support, unemployment, low education, ≥3 months post graft, living donor, ≥6 comorbidities, ≥5 drugs/d, ≥2 intakes/d, negative beliefs, negative behavior, depression and anxiety were the factors significantly related to non-adherence. Conclusion As there are no established guidelines, consideration should be given to more than one approach to identify medication non-adherence although self-reports should remain the cornerstone of adherence assessment.
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Affiliation(s)
- Stephanie Belaiche
- Institut de pharmacie, CHU Lille, 59000, Lille, France. .,EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, 59000, Lille, France.
| | - Bertrand Décaudin
- Institut de pharmacie, CHU Lille, 59000, Lille, France.,EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, 59000, Lille, France
| | - Sébastien Dharancy
- Service des Maladies de l'appareil digestif et de la Nutrition, CHU Lille, 59000, Lille, France.,Inserm U995 - LIRIC - Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France
| | - Christian Noel
- Service de Néphrologie, CHU Lille, 59000, Lille, France.,Inserm U995 - LIRIC - Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France
| | - Pascal Odou
- Institut de pharmacie, CHU Lille, 59000, Lille, France.,EA 7365 - GRITA - Groupe de Recherche sur les formes Injectables et les Technologies Associées, Univ. Lille, 59000, Lille, France
| | - Marc Hazzan
- Service de Néphrologie, CHU Lille, 59000, Lille, France.,Inserm U995 - LIRIC - Lille Inflammation Research International Center, Univ. Lille, 59000, Lille, France
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Edmondson D, von Känel R. Post-traumatic stress disorder and cardiovascular disease. Lancet Psychiatry 2017; 4:320-329. [PMID: 28109646 PMCID: PMC5499153 DOI: 10.1016/s2215-0366(16)30377-7] [Citation(s) in RCA: 182] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/18/2016] [Accepted: 10/21/2016] [Indexed: 02/08/2023]
Abstract
In this paper, a first in a Series of two, we look at the evidence for an association of post-traumatic stress disorder with incident cardiovascular disease risk and the mechanisms that might cause this association, as well as the prevalence of post-traumatic stress disorder due to cardiovascular disease events and its associated prognostic risk. We discuss research done after the publication of previous relevant systematic reviews, and survey currently funded research from the two most active funders in the field: the National Institutes of Health and the US Veterans Administration. We conclude that post-traumatic stress disorder is a risk factor for incident cardiovascular disease, and a common psychiatric consequence of cardiovascular disease events that might worsen the prognosis of the cardiovascular disease. There are many candidate mechanisms for the link between post-traumatic stress disorder and cardiovascular disease, and several ongoing studies could soon point to the most important behavioural and physiological mechanisms to target in early phase intervention development. Similarly, targets are emerging for individual and environmental interventions that might offset the risk of post-traumatic stress disorder after cardiovascular disease events.
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Affiliation(s)
- Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, New York City, NY, USA.
| | - Roland von Känel
- Department of Psychosomatic Medicine, Clinic Barmelweid, Barmelweid, Switzerland
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Annema C, Drent G, Roodbol PF, Metselaar HJ, Van Hoek B, Porte RJ, Schroevers MJ, Ranchor AV. A prospective cohort study on posttraumatic stress disorder in liver transplantation recipients before and after transplantation: Prevalence, symptom occurrence, and intrusive memories. J Psychosom Res 2017; 95:88-93. [PMID: 28185646 DOI: 10.1016/j.jpsychores.2017.01.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 01/26/2017] [Accepted: 01/29/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This study aimed at increasing the understanding of posttraumatic stress disorder (PTSD) in liver transplant patients by describing the course of PTSD, symptom occurrence, psychological co-morbidity, and the nature of re-experiencing symptoms. METHODS A prospective cohort study was performed among 95 liver transplant recipients from before transplantation up until one year post-transplantation. Respondents filled out a questionnaire regarding psychological functioning (PTSD, anxiety, and depression) before, and at 3, 6, and 12months post-transplantation. Both quantitative and qualitative methods were used to analyze the data. RESULTS Before transplantation, respectively 10.5% and 6.3% of the respondents were identified as possible cases of full or partial PTSD. In all cases, co-morbid conditions of anxiety and/or depression were present. After transplantation, no new onset of full PTSD was found. New onset of possible partial PTSD was found in six respondents. Arousal symptoms were the most frequently reported symptoms, but may not be distinctive for PTSD in transplant patients because of the overlap with disease- and treatment-related symptoms. Re-experiencing symptoms before transplantation were mostly related to waiting for a donor organ and the upcoming surgery; after transplantation this was related to aspects of the hospital stay. CONCLUSIONS In our group of liver transplant patients, PTSD symptomatology was more present before transplantation than after transplantation. Being diagnosed with a life-threatening disease seemed to be the main stressor. However, when a diagnosis of PTSD is suspected, assessment by a clinician is warranted because of the overlap with mood and anxiety disorders, and disease- and treatment-related symptoms.
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Affiliation(s)
- Coby Annema
- University of Groningen, University Medical Center Groningen, School of Nursing & Health, Groningen, The Netherlands.
| | - Gerda Drent
- University of Groningen, University Medical Center Groningen, Department of Gastroenterology and Hepatology, Groningen, The Netherlands
| | - Petrie F Roodbol
- University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
| | - Herold J Metselaar
- Erasmus Medical Center, Department of Gastroenterology and Hepatology, Rotterdam, The Netherlands
| | - Bart Van Hoek
- Leiden University Medical Center, Department of Gastroenterology and Hepatology, Leiden, The Netherlands
| | - Robert J Porte
- University of Groningen, University Medical Center Groningen, Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Groningen, The Netherlands
| | - Maya J Schroevers
- University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
| | - Adelita V Ranchor
- University of Groningen, University Medical Center Groningen, Department of Health Psychology, Groningen, The Netherlands
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Mindlis I, Morales-Raveendran E, Goodman E, Xu K, Vila-Castelar C, Keller K, Crawford G, James S, Katz CL, Crowley LE, de la Hoz RE, Markowitz S, Wisnivesky JP. Post-traumatic stress disorder dimensions and asthma morbidity in World Trade Center rescue and recovery workers. J Asthma 2016; 54:723-731. [PMID: 27905829 DOI: 10.1080/02770903.2016.1263650] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Using data from a cohort of World Trade Center (WTC) rescue and recovery workers with asthma, we assessed whether meeting criteria for post-traumatic stress disorder (PTSD), sub-threshold PTSD, and for specific PTSD symptom dimensions are associated with increased asthma morbidity. METHODS Participants underwent a Structured Clinical Interview for Diagnostic and Statistical Manual to assess the presence of PTSD following DSM-IV criteria during in-person interviews between December 2013 and April 2015. We defined sub-threshold PTSD as meeting criteria for two of three symptom dimensions: re-experiencing, avoidance, or hyper-arousal. Asthma control, acute asthma-related healthcare utilization, and asthma-related quality of life data were collected using validated scales. Unadjusted and multiple regression analyses were performed to assess the relationship between sub-threshold PTSD and PTSD symptom domains with asthma morbidity measures. RESULTS Of the 181 WTC workers with asthma recruited into the study, 28% had PTSD and 25% had sub-threshold PTSD. Patients with PTSD showed worse asthma control, higher rates of inpatient healthcare utilization, and poorer asthma quality of life than those with sub-threshold or no PTSD. After adjusting for potential confounders, among patients not meeting the criteria for full PTSD, those presenting symptoms of re-experiencing exhibited poorer quality of life (p = 0.003). Avoidance was associated with increased acute healthcare use (p = 0.05). Sub-threshold PTSD was not associated with asthma morbidity (p > 0.05 for all comparisons). CONCLUSIONS There may be benefit in assessing asthma control in patients with sub-threshold PTSD symptoms as well as those with full PTSD to more effectively identify ongoing asthma symptoms and target management strategies.
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Affiliation(s)
- I Mindlis
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - E Morales-Raveendran
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - E Goodman
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - K Xu
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - C Vila-Castelar
- b The Graduate Center, City University of New York , New York , NY , USA.,c Queens College, City University of New York , Flushing , NY , USA
| | - K Keller
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - G Crawford
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - S James
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - C L Katz
- d Department of Psychiatry , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - L E Crowley
- e Department of Preventive Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - R E de la Hoz
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
| | - S Markowitz
- c Queens College, City University of New York , Flushing , NY , USA
| | - J P Wisnivesky
- a Division of General Internal Medicine , Icahn School of Medicine at Mount Sinai , New York , NY , USA.,f Division of Pulmonary , Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai , New York , NY , USA
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Miloyan B, Bulley A, Bandeen-Roche K, Eaton WW, Gonçalves-Bradley DC. Anxiety disorders and all-cause mortality: systematic review and meta-analysis. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1467-1475. [PMID: 27628244 PMCID: PMC5102798 DOI: 10.1007/s00127-016-1284-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 09/07/2016] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to perform a systematic review and meta-analysis of prospective cohort studies that examined the relationship between anxiety disorders, or clinically significant anxiety symptoms, at baseline and all-cause mortality at follow-up relative to control participants without clinically significant anxiety. METHODS PubMed, EMBASE, PsycInfo, and CINAHL were searched through July 2015, along with manual searches of published reviews and forward and backward snowball searches of included studies. Studies were excluded if anxiety was not defined with a standardized instrument, or if participants were followed-up for 1 year or less. The initial search yielded 7901 articles after the removal of duplicates, of which 328 underwent full-text screening. RESULTS Forty-two estimates from 36 articles were included in the meta-analysis with a total sample of 127,552 participants and over 11,573 deaths. The overall hazard ratio (HR) estimate of mortality in clinically anxious participants relative to controls was 1.09 (95 % CI 1.01-1.16); however, this was reduced after adjusting for publication bias (1.03; 95 % CI 0.95-1.13). There was no evidence of increased mortality risk among anxious participants derived from community samples (0.99; 95 % CI 0.96-1.02) and in studies that adjusted for a diagnosis of depression (1.01; 95 % CI 0.96-1.06). CONCLUSIONS These findings suggest that positive associations in the literature are attributable to studies in smaller samples, comorbid depression (or other psychiatric conditions) among participants, and possible confounding in medical patient samples followed-up for short durations.
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Affiliation(s)
- Beyon Miloyan
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Adam Bulley
- School of Psychology, The University of Queensland, St Lucia, QLD, Australia
| | - Karen Bandeen-Roche
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - William W Eaton
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Conway A, Sheridan J, Maddicks-Law J, Fulbrook P, Ski CF, Thompson DR, Doering LV. Accuracy of anxiety and depression screening tools in heart transplant recipients. Appl Nurs Res 2016; 32:177-181. [DOI: 10.1016/j.apnr.2016.07.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/27/2016] [Accepted: 07/30/2016] [Indexed: 10/21/2022]
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Conway A, Sheridan J, Maddicks-Law J, Fulbrook P, Ski CF, Thompson DR, Clark RA, Doering LV. Depression and Pain in Heart Transplant Recipients. Biol Res Nurs 2016; 19:71-76. [DOI: 10.1177/1099800416666717] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Characterizing how physical and psychological symptoms interact in heart transplant recipients may lead to advances in therapeutic options. This study examined associations between pain and major depression. Method: A cross-sectional study was conducted with adult heart transplant recipients. Pain was measured with the bodily pain domain of the Short Form-36 Health Survey and psychological distress with the Kessler Psychological Distress Scale (K-10). The Mini International Neuropsychiatric Interview, version 6.0, was used to identify participants meeting the criteria for major depression. Hierarchical linear regression was used to determine if there was an association between pain and major depression, controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics including immunosuppression medication which may induce pain as a side effect. Results: Average pain score of the 48 heart transplant recipients was 43 ( SD ± 10, range 0–100, lower scores indicate worse pain), with moderate pain reported by 39% ( n = 19). Major depression was associated with worse pain ( R2 change = 36%, β = −16, 95% confidence interval [CI] = [−30, −4], p = .012). Pharmacological treatment for depression was associated with better pain scores ( R2 change = 1.5%, β = 13, 95% CI [4, 23], p = .006). Conclusions: Heart transplant recipients with major depression had worse pain after controlling for pharmacological treatment of depression, severity of psychological distress, and clinical characteristics. Thus, it is imperative that clinicians devising a treatment regimen for pain in heart transplant recipients take into account co-occurring depression and vice versa.
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Affiliation(s)
- Aaron Conway
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Australia
| | - Judith Sheridan
- School of Psychology, Queensland University of Technology, Kelvin Grove, Australia
| | - Joanne Maddicks-Law
- Advanced Heart Failure and Transplant Unit, The Prince Charles Hospital, Chermside, Australia
| | - Paul Fulbrook
- Nursing Research and Practice Development Unit, The Prince Charles Hospital, Chermside, Australia
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Brisbane, Australia
| | - Chantal F. Ski
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - David R. Thompson
- Centre for the Heart and Mind, Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Robyn A. Clark
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia
| | - Lynn V. Doering
- School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA
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Psychiatric Predictors of Long-term Transplant-Related Outcomes in Lung Transplant Recipients. Transplantation 2016; 100:239-47. [PMID: 26177087 DOI: 10.1097/tp.0000000000000824] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Long-term survival after lung transplantation remains poor, yet modifiable risk factors for late-term morbidity and mortality have yet to be identified. Because psychiatric disorders increase risk for poor health outcomes in many nontransplant chronic disease populations, lung recipients with depression or anxiety before or early after transplantation may be at heightened risk for late-term transplant-related morbidity and mortality. METHODS Among 178 patients from a prospective study of mental health after lung transplantation, we identified 1-year survivors and examined whether they experienced major depression or anxiety disorders during that year as well as before transplantation. We used multivariable Cox regression to examine the relationship between these disorders and risk for subsequent bronchiolitis obliterans syndrome (BOS), mortality and graft loss for up to 15 years posttransplant, controlling for other known risk factors for the outcomes. RESULTS One hundred fifty-five recipients were studied. Recipients with posttransplant depression had an elevated risk of BOS (hazard ratio [HR], 1.91; 95% confidence interval [95% CI], 1.10-3.31), patient death (HR, 1.65; 95% CI, 1.01-2.71) and graft loss (HR, 1.75; 95% CI, 1.06-2.88). A trend toward reduced risk of BOS was observed in recipients with posttransplant anxiety (HR, 0.61; 95%CI, 0.37-1.00). Neither pretransplant disorder was related to risk for any outcome. CONCLUSIONS Early posttransplant depression increases risk for long-term transplant-related morbidity and mortality. Screening to identify depression should therefore be routine in posttransplant care. Although anxiety was not significantly associated with poor outcomes, screening for posttransplant anxiety should also be routine, to reduce patient distress. Research is needed to better understand mechanisms underlying depression-outcome associations.
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Prevalence and Correlates of Post-traumatic Stress Disorder in Adults With Congenital Heart Disease. Am J Cardiol 2016; 117:853-7. [PMID: 26803381 DOI: 10.1016/j.amjcard.2015.11.065] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 11/24/2015] [Accepted: 11/24/2015] [Indexed: 11/20/2022]
Abstract
Post-traumatic stress disorder (PTSD) is associated with adverse outcomes and increased mortality in cardiac patients. No studies have examined PTSD in the adult congenital heart disease (ACHD) population. The objectives of this study were to assess the prevalence of self-reported symptoms of PTSD in patients with ACHD and explore potential associated factors. Patients were enrolled from an outpatient ACHD clinic and completed several validated measures including the Impact of Event Scale-Revised, PTSD Checklist-Civilian Version, and the Hospital Anxiety and Depression Scale. Clinical data were abstracted through medical data review. A total of 134 participants (mean age 34.6 ± 10.6; 46% men) were enrolled. Of the 127 participants who completed the Impact of Event Scale-Revised, 14 (11%) met criteria for elevated PTSD symptoms specifically related to their congenital heart disease or treatment. Of the 134 patients who completed PTSD Checklist-Civilian Version, 27 (21%) met criteria for global PTSD symptoms. In univariate analyses, patients with congenital heart disease-specific PTSD had their most recent cardiac surgery at an earlier year (p = 0.008), were less likely to have attended college (p = 0.04), had higher rates of stroke or transient ischemic attack (p = 0.03), and reported greater depressive symptoms on the Hospital Anxiety and Depression Scale (7 vs 2, p <0.001). In multivariable analysis, the 2 factors most strongly associated with PTSD were depressive symptoms (p <0.001) and year of most recent cardiac surgery (p <0.03). In conclusion, PTSD is present in 11% to 21% of subjects seen at a tertiary referral center for ACHD. The high prevalence of PTSD in this complex group of patients has important implications for the medical and psychosocial management of this growing population.
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