Cross-sectional assessment of psychiatric disorders in renal transplantation patients in Turkey: a preliminary study.

BACKGROUND: Psychiatric disorders such as depression and anxiety may be seen after a successful renal transplantation (RTx). The aim of this cross-sectional study was the assessment of psychiatric disorders after RTx in Turkey. The value of self-report scales in predicting depression and anxiety was also assessed. PATIENTS AND METHODS: The study group consisted of 20 male and 20 female RTx patients (mean age 35.42 +/- 10.09 years), with a mean duration of 61.65 +/- 48.30 months of follow-up after transplantation. All patients were assessed with the validated Turkish versions of Structured Clinical Interview for the DSM-IV (SCID-I), Beck Depression Inventory (BDI), Hospital Anxiety Depression Scales (HADS), Spielberger Trait Anxiety Inventory (STAI-I), and Beck Hopelessness Scale (BHS). RESULTS: Twenty of the 40 patients warranted a DSM-IV psychiatric diagnosis with SCID-I evaluation. Major depression was observed in 25% of patients. The remaining diagnoses were within the affective and/or anxiety spectrum disorders. The set of age, gender, education, income, marital status, employment, type of transplantation, duration of illness, and duration after the transplantation was not significantly different between patients with or without psychiatric diagnoses. BDI, HADS, STAI-I, and BHS were significantly higher among patients with psychiatric diagnoses at P = .001 level using Student t test. Even after control of the variance explained by the set of demographic variables, hierarchical regression analysis revealed that HADS scores significantly predicted the psychiatric morbidity (P = .003). CONCLUSION: The frequency of psychiatric disorders is quite high in renal transplantation patients. Additionally, HADS, which significantly predicts depression and anxiety, may be used for screening purposes.

Suicidal behavior, satisfaction with life, and perceived social support in end-stage renal disease.

BACKGROUND: Suicide has been rarely studied among end-stage renal disease (ESRD) patients. The purpose of this study is to assess the frequency of suicidal thoughts, plans, and attempts among ESRD patients including the interactions among suicidal behavior, the level of social support, and satisfaction with life. PATIENTS AND METHODS: The study group, of medically stable kidney recipients, including 20 men and 20 women had a mean 121.81 +/- 72.72-months follow-up for ESRD. All patients were administered a questionnaire including demographic and clinical characteristics; specific questions about psychiatry consultations, as well as questions about suicidal thoughts, plans, and attempts before and after transplantation. Patient responses were confirmed by chart reviews; inconsistencies were clarified with the patients. Additionally, all patients completed a validated Turkish version of two self-report scales, Satisfaction with Life Scale (SLS) and Multidimensional Scale of Perceived Social Support (MSPSS). RESULTS: In total, psychiatrists assessed 19 ESRD patients, including all suicidal patients. Eight patients reported "suicidal thoughts-plans," including two attempts. MSPSS results revealed that a history of psychiatric consultation (P <.05) and "suicidal thoughts-plans," (P <.05) significantly correlated with lower MSPSS scores. MSPSS scores were correlated with SLS (P <.05). Of all patients, six reported "suicidal thoughts-plans," including one suicide attempt prior to transplantation. Of six patients, one was married and five were not (P <.05). Among the three patients who reported suicidal thoughts-plans in the posttransplantation period, two, including one attempter, were new cases. CONCLUSIONS: High rates of suicidal thoughts-plans and attempts were found among our ESRD patients. The probability of suicidal behavior significantly increased among recipients that were single or divorced; whose satisfaction with life was decreased; and who perceived their family, friends, and significant others to be less supportive. More detailed prospective studies on suicide are needed for better care of ESRD patients.