Seligman's Theory of Attributional Style: Optimism, Pessimism, and Quality of Life after Heart Transplant

Advances in fertility preservation and pregnancy care for transplant patients

Fertility preservation and pregnancymanagement are critical considerations for patients undergoing organtransplantation. Innovations in assisted reproductive technologies, hormonalmodulation, and personalized medicine have expanded options for these patients, who face unique challenges due to immunosuppressive therapy and organ functionconcerns. This mini-review explores advancements in cryopreservationtechniques, pre-conception counseling, and multidisciplinary strategies forsafe pregnancies post-transplantation. Emphasis is placed on balancing maternalhealth, graft function, and fetal outcomes. The integration of reproductive andtransplant medicine is paving the way for improved quality of life andreproductive autonomy for this patient population.

Coping, Mood, Quality of Life, and Outcomes in Recipients of Left Ventricular Assist Devices: A Cluster Analysis

OBJECTIVE

Left ventricular assist devices (LVADs) are increasingly used for temporary circulatory support until transplant or as destination therapy for patients with end-stage heart failure. Understanding patients' attitudes and resources is crucial to support them.

METHODS

Sixty-one LVAD recipients (55 [10] years, 10% women, 15% destination therapy) participating in cardiac rehabilitation (CR) postimplant underwent assessment of coping styles (Coping Orientation for Problem Experiences), quality of life (Medical Outcomes Study Short-Form 36, Minnesota Living with Heart Failure Questionnaire), and mood (Hospital Anxiety and Depression Scale).

RESULTS

Cluster analysis identified two homogeneous groups: C1 (n = 18) patients had higher anxiety (9.6 [5.0] versus 4.0 [2.7], p < .001), depression (10 [3.0] versus 4 [2.7], p < .001), and avoidant coping (29 [5.2] versus 21.2 [3.8], p < .001) scores and worse quality of life (Short-Form 36 of the Medical Outcomes Study Physical Component Scale 31 [5.3] versus 35.6 [6.9], p < .001; Mental Component Scale 34.3 [6.8] versus 50.3 [8], p < .001; MLHFQ physical 26 [7.2] versus 13.9 [8.2], p < .001; emotional 17.7 [3.4] versus 3.86 [3.2], p < .001) than C2 participants (n = 43). During 31 (15-54) months, 20 patients (33%) died. By Cox multivariable analysis, after adjustment for age, sex, Interagency Registry for Mechanically Assisted Circulatory Support level at surgery, and meters walked during 6 minutes at CR discharge, C1 was associated with mortality (hazard ratio = 2.858; 95% confidence interval = 1.102-7.408, p = .031; model χ = 7.286, df = 5, p = .20). Survival was 44% in C1 and 77% in C2 (log-rank p = .033).

CONCLUSIONS

Among patients discharged from CR after LVAD implant, one third show a profile characterized by worse perceived quality of life, mood disorders, and dysfunctional coping that is associated with long-term mortality, and these factors are potential targets for post-LVAD intensive support.

Impact of Affect on Lung Transplant Candidate Outcomes

BACKGROUND

We examined the association of adult lung transplant candidates' self-reported affect with transplant-related outcomes, evaluating whether a positive (vs negative) frame of mind might be protective.

METHOD

Consenting waitlisted candidates from 6 centers completed the questionnaires including the Positive and Negative Affect Schedule annually and posttransplant. Univariate logistic regression analysis was performed to determine the association of baseline affect with outcomes of death or delisting. Models were subsequently adjusted for age, marital status, and education.

RESULTS

Questionnaires were completed by 169 candidates (77.9% participation). Mean positive affect, negative affect, and positive-to-negative affect ratio (positivity ratio) were similar to expected norms. The scores of the questionnaire did not change significantly over time. Fifteen (8.9%) waitlisted participants died. Candidates who died while waiting had lower positivity ratios compared to those who survived (1.82 vs 2.45; P = .02). A more negative affect was associated with increased death on the waiting list (adjusted odds ratio [OR] 1.10; P = .021). Conversely, a higher positivity ratio was associated with decreased death while waiting (adjusted OR: 0.45; P = .027).

CONCLUSION

Negative affect may represent a novel risk factor for death on the waitlist. Enhancing positive affect may represent a useful target for psychological optimization in lung transplant candidates.

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

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.

Optimism as predictor of patient-reported outcomes in patients with an implantable cardioverter defibrillator (data from the WEBCARE study)

OBJECTIVE

The implantable cardioverter defibrillator (ICD) is the treatment of choice for prevention of sudden cardiac death. However, a subgroup of ICD patients experiences psychological adjustment problems post implant. To date, positive psychological constructs (e.g. optimism) have been understudied in this population. Hence, we examined the association between optimism and anxiety, depression, and health status at 12-months post implant.

METHODS

Patients (N=171) enrolled in the WEB-based distress management study for ICD patients were included in the analyses. Optimism and pessimism (LOT), and Type D personality (DS14) were administered at baseline, while anxiety (GAD-7), depression (PHQ-9), and health status (SF-12) were assessed at 12-months.

RESULTS

The mean age was 59.6±10.06 with 81% being male. After controlling for demographic, personality, and clinical variables, baseline optimism was associated with lower anxiety (β=-0.210; p=0.011) and depression (β=-0.222; p=0.005), and better physical (β=0.227; p=0.004) and mental health status (β=0.350; p=0.000) at follow-up. Optimism was also associated with change in mental health status (β=0.195; p=0.007) but not with change in anxiety, depression, and physical health status at follow-up.

CONCLUSIONS

Our findings indicate that optimism is associated with less distress and possibly helps safeguard mental health in ICD patients. Increase optimism might be the way forward to reduce long-term distress and impaired health status.

TRIAL REGISTRATION

http://www.ClinicalTrials.gov. Identifier: NCT00895700.

Explanatory Style in Patients with Rheumatoid Arthritis: An Unrecognized Predictor of Mortality

OBJECTIVE

To determine whether pessimistic explanatory style altered the risk for and mortality of patients with rheumatoid arthritis (RA).

METHODS

The study included subjects from a population-based cohort with incident RA and a non-RA comparison cohort who completed the Minnesota Multiphasic Personality Inventory.

RESULTS

Among 148 RA and 135 non-RA subjects, pessimism was associated with development of rheumatoid factor (RF)-positive RA. Pessimism was associated with an increased risk of mortality [HR 2.88 with similar magnitude to RF+ (HR 2.28)].

CONCLUSION

Pessimistic explanatory style was associated with an increased risk of developing RA and increased mortality rate in patients with RA.

Adjusting to Chronic Health Conditions

Research on adjustment to chronic disease is critical in today's world, in which people are living longer lives, but lives are increasingly likely to be characterized by one or more chronic illnesses. Chronic illnesses may deteriorate, enter remission, or fluctuate, but their defining characteristic is that they persist. In this review, we first examine the effects of chronic disease on one's sense of self. Then we review categories of factors that influence how one adjusts to chronic illness, with particular emphasis on the impact of these factors on functional status and psychosocial adjustment. We begin with contextual factors, including demographic variables such as sex and race, as well as illness dimensions such as stigma and illness identity. We then examine a set of dispositional factors that influence chronic illness adjustment, organizing these into resilience and vulnerability factors. Resilience factors include cognitive adaptation indicators, personality variables, and benefit-finding. Vulnerability factors include a pessimistic attributional style, negative gender-related traits, and rumination. We then turn to social environmental variables, including both supportive and unsupportive interactions. Finally, we review chronic illness adjustment within the context of dyadic coping. We conclude by examining potential interactions among these classes of variables and outlining a set of directions for future research.

Optimism During Hospitalization for First Acute Myocardial Infarction and Long-Term Mortality Risk: A Prospective Cohort Study

OBJECTIVE

To assess the association between dispositional optimism, defined as generalized positive expectations about the future, and long-term mortality in young survivors of myocardial infarction (MI).

PATIENTS AND METHODS

A subcohort of 664 patients 65 years and younger, drawn from the longitudinal Israel Study of First Acute Myocardial Infarction, completed an adapted Life Orientation Test (LOT) questionnaire during their index hospitalization between February 15, 1992, and February 15, 1993. Additional sociodemographic, clinical, and psychosocial variables were assessed at baseline; mortality follow-up lasted through December 31, 2015. Cox proportional hazards regression models were fit to assess the hazard ratios for mortality associated with LOT-derived optimism.

RESULTS

The mean age of the participants was 52.4±8.6 years; 98 (15%) were women. The median follow-up period was 22.4 years (25th-75th percentiles, 16.1-22.8 years), during which 284 patients (43%) had died. The mean LOT score was 16.5±4.1. Incidence density rates for mortality in increasing optimism tertiles were 25.4, 25.8, and 16.0 per 1000 person-years, respectively (P<.01). With sequential adjustment for sociodemographic, clinical, and psychosocial variables, a decreased mortality was associated with the upper tertile (adjusted hazard ratio, 0.67; 95% CI, 0.47-0.95). A nonlinear inverse relationship was observed using spline analysis, with the slope increasing sharply beyond the median LOT score.

CONCLUSION

Higher levels of optimism during hospitalization for MI were associated with reduced mortality over a 2-decade follow-up period. Optimism training and positive psychology should be examined as part of psychosocial interventions and rehabilitation after MI.

Explaining the quality of life of organ transplant patients by using crisis theory

CONTEXT

Ubiquitous findings regarding the quality of life (QOL) of transplant patients have yet to be explained from a theoretical perspective.

OBJECTIVE

To investigate transplant patients' QOL by using the conceptual framework of crisis theory.

DESIGN

Cross-sectional study to explore differences in transplant patients' experiences of stress, coping, and QOL. Regression analysis was used to test crisis theory in relation to QOL, stress, and coping.

PARTICIPANTS

A total of 226 participants representing transplant candidates, transplant recipients, and nontransplant individuals participated via survey-based data collection.

RESULTS

Results showed that transplant candidates experience lower QOL than transplant recipients and nontransplant individuals. No significant differences were detected regarding stress levels or coping styles. Stress made a significant contribution to patients' QOL.

CONCLUSIONS

Current findings suggest important QOL benefits of organ transplant. Using a theoretical model is an effective way to investigate the QOL of people experiencing chronic illness such as end-stage organ failure. Further investigation is required to reach a conclusive understanding of the complex interaction between transplant patients' QOL, stress, and coping.

Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: A systematic review

Depression and anxiety are well-known to be associated with adverse health outcomes in cardiac patients. However, there has been less work synthesizing the effects of positive psychological constructs (e.g., optimism) on health-related outcomes in cardiac patients. We completed a systematic review of prospective observational studies using established guidelines. A search of PubMed and PsycINFO databases from inception to January 2014 was used to identify articles. To be eligible, studies were required to assess effects of a positive psychological construct on subsequent health-related outcomes (including mortality, rehospitalizations, self-reported health status) in patients with established heart disease. Exploratory random effects' meta-analyses were performed on the subset of studies examining mortality or rehospitalizations. Seventy-seven analyses from 30 eligible studies (N=14,624) were identified. Among studies with 100 or more participants, 65.0% of all analyses and 64.7% of analyses adjusting for one or more covariates reported a significant (p<.05) association between positive psychological constructs and subsequent health outcomes. An exploratory meta-analysis of 11 studies showed that positive constructs were associated with reduced rates of rehospitalization or mortality in unadjusted (odds ratio=.87; 95% confidence interval [.83, .92]; p<.001) and adjusted analyses (odds ratio=.89; 95% confidence interval [.84, .91]; p<.001); there was little suggestion of publication bias. Among cardiac patients, positive psychological constructs appear to be prospectively associated with health outcomes in most but not all studies. Additional work is needed to identify which constructs are most important to cardiac health, and whether interventions can cultivate positive attributes and improve clinical outcomes.

Illness apprehension, depression, anxiety, and quality of life in liver transplant candidates: implications for psychosocial interventions

BACKGROUND

End-stage liver disease is associated with diminished quality of life (QOL). Numerous physical and psychosocial problems that affect QOL are common in those undergoing evaluation for liver transplantation.

OBJECTIVE

Identifying which of these challenges are most closely associated with QOL would be helpful in developing priority targets for evidence-based interventions specific to those undergoing transplant evaluation.

METHOD

A total of 108 adults undergoing psychologic assessment for liver transplant completed clinical interview, neuropsychologic testing, and self-report inventories of depression, anxiety, cognitive appraisal characteristics, support resources, and QOL.

RESULTS

Multiple regression analyses revealed that while emotional symptoms (anxiety and depression) were primarily associated with mental QOL, illness apprehension was the only variable uniquely associated with physical QOL after accounting for severity of liver disease, cognitive status, emotional symptoms, and support resources.

CONCLUSION

Findings suggest that psychosocial interventions prioritizing reduction of illness-related fear and symptoms of anxiety/depression would likely have the greatest effect on QOL in persons with end-stage liver disease awaiting transplantation.

Optimism measured pre-operatively is associated with reduced pain intensity and physical symptom reporting after coronary artery bypass graft surgery

OBJECTIVE

Optimism is thought to be associated with long-term favourable outcomes for patients undergoing coronary artery bypass graft (CABG) surgery. Our objective was to examine the association between optimism and post-operative pain and physical symptoms in CABG patients.

METHODS

We assessed optimism pre-operatively in 197 adults undergoing CABG surgery, and then followed them up 6-8 weeks after the procedure to measure affective pain, pain intensity, and physical symptom reporting directly pertaining to CABG surgery.

RESULTS

Greater optimism measured pre-operatively was significantly associated with lower pain intensity (β=-0.150, CI=-0.196 to -0.004, p=.042) and fewer physical symptoms following surgery (β=-0.287, CI=-0.537 to -0.036, p=.025), but not with affective pain, after controlling for demographic, clinical and behavioural covariates, including negative affectivity.

CONCLUSIONS

Optimism is a modest, yet significant, predictor of pain intensity and physical symptom reporting after CABG surgery. Having positive expectations may promote better recovery.

Attributional styles and stress-related atherogenic plasma lipid reactivity in essential hypertension

OBJECTIVE

Hypertension and an atherogenic lipid profile are known risk factors for coronary heart disease (CHD). Hypertensives show greater changes in atherogenic plasma lipids to acute stress than normotensives. In this study, we investigated whether attribution of failure is associated with lipid stress reactivity in hypertensive compared with normotensive men.

METHODS

18 normotensive and 17 hypertensive men (mean±SEM; 45±2.2 years) underwent an acute standardized psychosocial stress task that can be viewed as a situation of experimentally induced failure. We assessed external-stable (ES), external-variable (EV), internal-stable (IS), and internal-variable (IV) attribution of failure and psychological control variables (i.e. extent of depression and neuroticism). Moreover, total cholesterol (TC), low-density-lipoprotein cholesterol (LDL-C), and norepinephrine were measured immediately before and several times after stress.

RESULTS

ES moderated TC- and LDL-C-stress reactivity in hypertensives as compared to normotensives (interaction mean arterial pressure [MAP]-by-ES for TC: F=3.71, p=.015; for LDL-C: F=3.61, p=.016). TC and LDL-C levels were highest in hypertensives with low ES immediately after stress (p≤.039). In contrast, hypertensives with high ES did not differ from normotensives in TC and LDL-C immediately after stress (p's>.28). Controlling for norepinephrine, depression, and neuroticism in addition to age and BMI did not significantly change results. There were no significant associations between lipid baseline levels or aggregated lipid secretion and IS, IV, or EV (p's>.23).

CONCLUSION

Our data suggest that ES may independently protect from elevated lipid stress reactivity in hypertensive individuals. ES thus might be a protective factor against CHD in hypertension.