Post-Traumatic Stress Disorder and Post-Traumatic Growth following Kidney Transplantation.

Background: Kidney transplantation (KT) is a life-saving therapy for kidney failure. However, KT recipients can suffer from debilitating depression, post-traumatic stress disorder (PTSD), and suicide. In contrast to PTSD, post-traumatic growth (PTG) is a positive psychologic change in response to a challenging situation. PTG has been studied in other chronic diseases, but less is known about its role in the setting of KT. We sought to elucidate the prevalence, predictors, and the effect of PTSD and PTG on post-KT outcomes. We also considered the roles of benefit finding and resilience. Methods: In a literature review, we identified publications that examined PTSD, PTG, benefit finding, and/or resilience in KT recipients. We excluded case reports and first-person narratives. Publications meeting the specified criteria after full text review underwent data abstraction and descriptive analysis. Results: Of the 1013 unique citations identified, 39 publications met our criteria. PTSD was the most common construct evaluated (16 publications). Resilience was studied in 11 publications, PTG in nine, and benefit finding in five. Up to 21% of adult and 42% of pediatric KT recipients may experience PTSD, which is associated with lower quality of life (QOL), impaired sleep, and other psychiatric comorbidity. PTG was associated with improved QOL, kidney function, and reduced risk of organ rejection. Although benefit finding tended to increase post KT, resilience remained stable post KT. Like PTG, resilience was associated with lower psychologic distress and increased treatment adherence and confidence in the health care team. Conclusions: PTG, resilience, and benefit finding appear to reduce the risk of PTSD, promote well-being, and reduce risk of graft failure in KT recipients. Future research to understand these relationships better will allow clinicians and researchers to develop interventions to promote PTG, resilience, and benefit finding, and potentially improve post-transplant outcomes such as adherence and reducing risk of organ rejection.

Tablet therapy as an assistive technology-based treatment for anxiety in pediatric oncology.

The painful interventions and invasive procedures associated with pediatric cancer treatment can result in anxiety. Anxiety can be reduced or better controlled through distraction and thought retraining. Although art therapy, non-electronic play therapy, music therapy, and traditional counseling are often used to alleviate stress and anxiety, new technology innovations are proving to be additional options to decrease stress and anxiety through distraction and attention shifting. Tablet-based interventions are emerging as an easily available and effective means of reducing stress and fear prior to operations, and have potential applications to reduce anxiety for patients before receiving chemotherapy, during time spent in hospital rooms, and while experiencing distressing physiological symptoms. This paper reviews the research on tablet therapy and discusses the application of assistive technologies in clinical oncology settings to reduce pediatric anxiety throughout the treatment process.

Coping, Anxiety, and Health Care Transition Readiness in Youth with Chronic Conditions.

PURPOSE: To explore the relationship between coping and health care transition readiness, and to examine whether anxiety is a mediator between coping and health care transition readiness. DESIGN AND METHODS: A sample of 174 youths with various chronic conditions (age 13.03 ± 2.02 years, 48.3% male) attending the 2018 Victory Junction Camp and their parents participated. Youths and parents completed measures to assess coping (Kidcope Checklist), anxiety symptoms (PROMIS Anxiety scale), and transition readiness (STARx Questionnaire) through Qualtrics online surveys. RESULTS: Positive coping was positively related to transition readiness in both youth and parent-proxy reports, while negative coping was negatively related to transition readiness in youth reports. Anxiety mediated the relationship of positive coping and transition readiness in parent-proxy reports, and the relationship of negative coping and transition readiness in both youth self-reports and parent-reports. CONCLUSIONS: Coping is an important factor in transition readiness. Furthermore, anxiety is an important mediator, and may be more influential in the relationship of negative coping and transition readiness. PRACTICE IMPLICATIONS: Practitioners and health care providers can use these findings to promote the use of positive coping and reduce the use of negative coping, which in turn may improve outcomes for youth with chronic health conditions who are transitioning to adult health care services.

The Effect of Psychiatric History on Pain and Related Outcomes Among Living Kidney Donors.

INTRODUCTION: Living donor transplantation of kidneys accounts for one quarter of transplants performed in the United States. Careful screening of psychiatric history is a standard part of the donor evaluation. Little is known about the impact of psychiatric history on post-donation course and pain experience. RESEARCH QUESTION: This study investigated whether psychiatric history was associated with pain and related outcomes among living kidney donors. DESIGN: A retrospective medical record review was conducted of 75 living kidney donors who underwent laparoscopic donor nephrectomy. All donor candidates completed a psychological evaluation and were approved for donation by a multidisciplinary committee. History of psychiatric diagnosis and psychiatric medication use were obtained from donors' psychological evaluation reports. Data on pain and related outcomes (ie, history of prescribed pain medication, post-donation pain, opioid use, length of hospital stay, post-donation emergency department visits), as well as demographic and donation-related characteristics were also abstracted from medical records. RESULTS: Psychiatric history, including current or historical psychiatric diagnosis or psychiatric medication use, in living kidney donors who were evaluated and approved for donation by a transplant psychologist was not associated with greater perceived pain, greater use of opioid pain medication in the post-operative period, longer hospital stays, or more frequent post-donation emergency department visits. DISCUSSION: The findings demonstrate that carefully screened donors with a psychiatric history have comparable pain-related outcomes as donors without a psychiatric history. This study highlights the importance of the pre-donation psychological evaluation in promoting positive postdonation outcomes through careful selection of donor candidates.

Mental health and demographic correlates of loneliness after left ventricular assist device implantation.

Loneliness is a risk factor for coronary heart disease, stroke, and hospital readmission, yet there are no studies to our knowledge examining loneliness in left ventricular assistance device (LVAD) patients. This study used a cross-sectional survey design on a convenience sample of LVAD patients (n = 73). Logistic regression was used to identify demographic correlates of loneliness; linear regression was used to examine the relationship between loneliness and both stress and depression. Loneliness was measured via the loneliness item from the Center for Epidemiologic Studies Depression (CESD), depression via the CESD (excluding the loneliness item), and stress via the Perceived Stress Scale. In bivariate analyses, older age (OR per year = 0.958, 95%CI = 0.919-0.998) and being partnered (OR = 0.245, 95%CI = 0.083-0.724) were associated with less loneliness. In the multivariate model, there was an interaction effect between age and partnership (p = 0.0212), where older age was protective against loneliness for non-partnered, but not partnered, patients. Higher loneliness was associated with higher stress (ß = 0.484, B = 5.687, 95%CI = 3.195-8.178) and depression (ß = 0.618, B = 7.544, 95%CI = 5.241-9.848). Patients who are not partnered and younger may be at increased risk of loneliness after LVAD. Loneliness in turn is associated with higher stress and depression. Longitudinal research is necessary to speak to direction of effects.

The relationship between marijuana use and psychosocial variables in living kidney donor candidates.

BACKGROUND: We investigate whether marijuana use in living kidney donor candidates is associated with psychosocial risk factors that place donors at higher risk for adverse outcomes and the unique associations between marijuana use and donor candidacy. METHODS: Medical records of 757 living kidney donor candidates were reviewed. Patients were grouped into marijuana users/abstainers; demographic, psychiatric, and substance use variables were compared. Multivariate logistic regression assessed the independent association of marijuana use on committee approval for donation. RESULTS: Marijuana use was associated with lack of health insurance, legal history, lower education level, active and history of substance use disorder, active psychiatric disorder, history of multiple psychiatric diagnoses, and history of suicidality. Marijuana users were also more likely to be young, male, unmarried, and less likely to be approved for donation by the multidisciplinary selection committee. This latter association persisted in multivariate models. CONCLUSIONS: This is the first study to show that marijuana use is associated with psychosocial factors that could impact behavioral adherence following kidney donation, while reducing chances of committee approval for kidney donation. Special attention to potential overlay between psychosocial risk factors and marijuana use should be considered when evaluating kidney donors, particularly in context of increasingly legal use.

Emergency medical services knowledge and attitudes about non-heart-beating donors: effect of an educational intervention.

BACKGROUND: More than 750,000 people die of sudden death each year, and many are potential non-heart-beating donors (NHBDs) for lung transplant. Although critical, the role of emergency medical services (EMS) personnel in assisting with recovery of NHBD lungs has not been studied. The purpose of this study was to assess knowledge of and attitudes about NHBDs among EMS personnel, evaluate the extent to which knowledge and personal experience with organ donation is associated with attitude, and ascertain the effectiveness of an intervention designed to teach EMS professionals about NHBDs. METHODS: EMS professionals (n = 361) completed measures of knowledge of and attitudes about NHBDs and then watched a presentation by a transplant doctor about traditional organ donation, NHBDs, and transplantation. Participants were able to ask questions during and after the presentation. Participants completed the measures again 3 months later. RESULTS: EMS professionals had a high rate of personal experience with organ donation and positive attitudes toward traditional organ donation. However, they showed lack of knowledge about NHBDs and felt less skilled in being part of the NHBD process, consistent with knowledge scores. The educational intervention was somewhat effective in improving knowledge about NHBDs. Scores improved significantly on 5 of 13 items. CONCLUSIONS: Lung recovery from NHBDs offers the potential of a very large supply for transplantation. This research suggests that with additional training, EMS professionals may be willing to be part of a NHBD recovery team.

Factors related to health locus of control among lung transplant candidates.

As the number of individuals pursuing lung transplantation to treat lung disease increases, transplant team members have an opportunity to maximize patients' chances for post-transplant success through identifying and addressing psychosocial factors that have been previously associated with patients' post-transplant survival, such as health locus of control (HLC). The purpose of this cross-sectional study was to understand the factors associated with HLC in lung transplant candidates. The aims were to (i) identify the demographic factors associated with internal (IHLC), chance (CHLC), and powerful others (PHLC) HLC; (ii) examine the associations between HLC and anxiety, depression, and optimism; and (iii) determine whether these factors explain a significant proportion of variance in HLC. Hierarchical regression analyses indicated that age, education, trait anxiety, and optimism explained 20% of the variance in CHLC; gender, trait anxiety, and depression accounted for 9% of the variance in IHLC; and lower education accounted for 5% of the variance in PHLC. Helping transplant team members understand the factors that influence patients' perceptions that their own behaviors impact their health status is important for maximizing post-transplant success.

The roles of social support and psychological distress in lung transplant candidacy.

CONTEXT: Social support appears to be an important component in lung transplantation. However, the relationship between social support, psychological distress, and listing status has not been evaluated in lung transplant candidates. OBJECTIVE: To evaluate the relationships between depression, anxiety, and social support in patients with end-stage lung disease being evaluated for transplantation and determine (1) relationships between social support, depression, anxiety, and coping via seeking emotional and instrumental support; (2) whether social support explains a significant proportion of the variance in depression and anxiety; and (3) whether these factors were associated with whether a patient was listed for transplant. DESIGN: For this observational study, patients completed self-report questionnaires after their pretransplant evaluations. Listing status was subsequently obtained from medical records. PATIENTS: Participants were patients with end-stage lung disease evaluated for transplantation at a major hospital. MEASURES: Medical Outcomes Study Social Support Survey, COPE Inventory, Beck Depression Inventory, and State-Trait Anxiety Inventory. RESULTS: Social support was associated with depression, anxiety, and seeking support (P values < .01). When other factors related to these variables were controlled for, social support explained a significant proportion of the variance in depression (9%), state anxiety (8%), and trait anxiety (7%; all P values <.001). Patients who were listed for transplant reported seeking more emotional and instrumental support than did patients who were not listed (all P values < or = .05). Whether a patient was listed for transplant was not associated with depression, state anxiety, trait anxiety, or availability of social support. Results highlight the important role that coping via seeking support plays in transplant candidacy.

Depressive symptoms and mortality in lung transplant.

OBJECTIVE: To determine whether depressive symptoms predicted survival before and after lung transplantation. We hypothesized that depressive symptoms might predict survival of wait-listed patients, but would not predict survival post-transplant. METHODS: This was a prospective, longitudinal study. Participants completed the Beck Depression Inventory pre-transplant. Pre-transplant survival analyses were conducted (n = 124) based on time from list date, to death, transplant, or censoring, if still alive. Post-transplant survival analyses were conducted (n = 76) based on time from transplant, to death or censoring. Cox proportional hazards regression analyses were utilized. RESULTS: In the unadjusted model, depressive symptoms predicted mortality for candidates awaiting lung transplant (p = 0.02); however, once models were adjusted for demographics and pulmonary status, the relationship between depressive symptoms and mortality rates was attenuated (p > 0.05). Depressive symptoms did not predict survival after lung transplant (p > 0.05). CONCLUSIONS: Pre-transplant depressive symptoms were associated with mortality among lung transplant candidates in an unadjusted model and a model fit with demographics and forced expiratory volume in one second. Depressive symptoms do not exert an independent effect when forced expiratory vital capacity is added. Depressive symptoms do not predict mortality after transplant. Future studies need to determine whether pre-transplant psychosocial characteristics confer a greater risk for poorer transplant outcomes.

Educational level, coping, and psychological and physical aspects of quality of life in heart transplant candidates.

OBJECTIVE: To determine whether demographic factors and coping strategies are related to quality of life in heart transplant candidates. METHOD: Participants were 50 inpatients being evaluated for heart transplant. Coping was measured using the COPE Inventory (1) (J Pers Soc Psychol, 56, 1989, 267). Quality of life was assessed using the SF-36 (2) (Health Survey: Manual and Interpretation Guide, Quality Metric Inc, Lincoln, RI, 2000). RESULTS: Higher education and less seeking of social support were independently associated with better physical functioning. Higher use of denial was associated with poorer mental health functioning. CONCLUSIONS: In patients with significant physical limitations, years of education appears to be protective. Less seeking of social support was associated with better physical functioning perhaps because individuals who feel better physically do not feel the need to elicit support. Alternatively, the tendency to not seek assistance could stem from personality characteristics such as avoidance or optimism. Denial was associated with worse mental health functioning. Denying the existence of a stressor may be a high risk coping strategy for patients who are pre-transplant and even more dangerous for those who are post-transplant given the need to be alert to symptoms. Proactive identification of patients at risk for poorer quality of life will allow for more timely psychosocial interventions, which could impact post-transplant outcomes.

Vocteer: a collaborative volunteer program for persons with severe psychiatric disabilities.

Vocteer is a university and community support agency collaborative program that matches undergraduate and graduate students with persons diagnosed with severe psychiatric disabilities in community-based volunteer positions. The program aims to improve self-esteem, community inclusion, and vocational skills of program participants. In addition, Vocteer helps participants develop skills necessary for employment or independent volunteering. The program, reports of participant satisfaction, and findings are described. Reports from the literature are presented and provide support for further exploration and development of such programs.

Relationship between coping and depression in heart transplant candidates and their spouses.

CONTEXT: Survival rates for heart transplantation are encouraging, but the pretransplant period can be extremely stressful for patients and their spouses. Although a relationship between patients' depression levels and the coping strategies employed by their spouses has been demonstrated, this association has not been examined in heart transplant candidates and their spouses. Depression in this group of patients is important because heart transplant patients with preoperative depression have been found to have a higher mortality rate after transplantation. OBJECTIVE: To determine if a relationship exists between spousal coping strategies and heart transplant candidates' depression. METHODS: A descriptive, exploratory pilot study. PARTICIPANTS: Twenty-two individuals with end-stage heart disease who were undergoing an inpatient evaluation for heart transplantation, plus their spouses. Design-Heart transplant candidates were assessed via the Structured Interview Guide for the Hamilton Depression Scale. Spouses completed the COPE Inventory and the Center for Epidemiological Studies Depression Scale. RESULTS: Spousal behavioral disengagement was positively associated with heart transplant candidates' depression. CONCLUSIONS: Heart transplant candidate depression may follow spousal disengagement, or, conversely, a spouse may disengage in response to the patient becoming depressed. Identification during the pretransplant evaluation of those spouses who cope using behavioral disengagement might be a first step in the process of assessment and intervention. Clinical interventions may need to focus on the spouse as well as on the transplant candidate.

Coping predicts depression and disability in heart transplant candidates.

OBJECTIVE: The aim of this study was to describe the coping strategies used by cardiac patients who are pursuing heart transplant and to determine which coping strategies are related to depression and self-reported disability. METHOD: This is a cross-sectional design with 50 cardiac patients (74% male) who were inpatients being evaluated for heart transplant at a large medical center. Coping styles were measured using the COPE Inventory (Carver CS, Scheier MF, Weintraub, JK. Assessing coping strategies: a theoretically based approach. J Pers Soc Psychol 1989;56:267-83). Depression was assessed with the Structured Interview Guide for the Hamilton Depression Rating Scale (HAM-SIGH-D; Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62), and disability was assessed using the Sickness Impact Profile (SIP; Bergner M, Bobbitt R, Carter W, Gilson B. The Sickness Impact Profile: development and final revision of a health status measure. Med Care 1981;19:787-805). RESULTS: Patients reported using a variety of adaptive coping strategies, but depression and disability were only significantly correlated with maladaptive coping strategies. Multiple regressions demonstrated that denial had the strongest association with depression, and focusing on and venting emotions had the strongest association with disability. CONCLUSIONS: Maladaptive coping styles, such as denial and focusing and venting of emotions, can serve as markers of emotional distress and disability that may identify patients who may benefit from psychologic and psychiatric interventions.

Religious and non-religious coping in lung transplant candidates: does adding god to the picture tell us more?

Individuals use many non-religious coping (NRC) and religious coping (RC) strategies to cope with stress. In previous studies with lung transplant candidates, we found that NRC and RC predicted depression, anxiety, and disability. The present study aimed to (a) assess whether RC and NRC contributed uniquely to the prediction of distress and disability, or whether they were redundant and offered no additional information, and (b) evaluate the unique contribution of each subscale to determine the strongest associations with outcomes. Participants were 81 patients with end-stage lung disease being evaluated for lung transplant. Our findings suggest that RC and NRC are not functionally redundant. The best RC predictor was reappraising the situation as a punishment from God, and the best NRC predictors were mental disengagement and denial. Our findings suggest that NRC and RC are independent components of psychological functioning, and measuring both coping styles provides more information than studying each alone.

Planning helps, behavioral disengagement does not: coping and depression in the spouses of heart transplant candidates.

OBJECTIVE: To describe the coping strategies used by the spouses of cardiac patients who are pursuing heart transplant and to determine whether coping strategies predict depression in these spouses. METHOD: This is a cross-sectional design with 28 spouses (86% female) of cardiac patients who were being evaluated for heart transplant at a large medical center. Coping styles were measured using the COPE Inventory (Carver CS, Scheier MF, Weintraub JK, J Pers Soc Psychol 1989: 56: 267). Depression was assessed with the Center for Epidemiological Studies Depression Scale (Radloff LS, Appl Psychol Meas 1977: 1: 385). RESULTS: Spouses reported using adaptive coping strategies more than the less adaptive strategies. Increased levels of depression were positively correlated with 'behavioral disengagement' and negatively correlated with 'planning' coping strategies. CONCLUSIONS: Most studies find that maladaptive coping styles are associated with psychological distress. Consistent with these findings, we found that behavioral disengagement was associated with increased levels of depression. However, in the present study the more adaptive coping strategy of planning was associated with lower levels of psychological distress. These findings suggest that in the spouses of heart transplant candidates, both maladaptive and adaptive coping strategies may serve as markers of the presence or absence of emotional distress and thus may help in identifying spouses who may benefit from psychological, social work, or nursing interventions.

Health locus of control predicts survival after lung transplant.

The purpose of this study was to assess whether health locus of control beliefs measured pre-transplant predicted survival after lung transplant. Participants were 100 patients who completed the Multidimensional Health Locus of Control scale before and after transplant. Cox proportional hazards regressions were used to investigate the relationship between each of the three subscales (IHLC, PHLC, CHLC) and survival time after transplant. After adjusting for age and medical diagnosis, participants with medium and high levels of IHLC had lower hazard ratios than those with low IHLC. Neither PHLC nor CHLC exhibited statistical differences in survival. Compared to patients with low IHLC, patients with medium and high levels of IHLC lived longer after lung transplant.

Tobacco and alcohol use in lung transplant candidates and recipients.

Tobacco and alcohol use among lung transplant candidates and recipients is unknown. Our first goal was to describe tobacco and alcohol use before and after lung transplant in patients with cystic fibrosis (CF) and other pulmonary diseases (non-CF). Our second goal was to determine whether demographic variables, depression, anxiety and social support predicted tobacco and alcohol use. Self-report data from transplant candidates and recipients, and transplant nurse coordinator ratings of post-transplant smoking and drinking were utilized. Data from two samples were analyzed. Sample 1 comprised 219 patients being evaluated for lung transplant, and sample 2 comprised 45 transplant recipients who were 1-7 yrs post-transplant. The results from analyzing sample 1 indicated that 72% of non-CF patients and 16% of CF patients had a history of smoking cigarettes, and the majority of patients in both groups had consumed alcohol in the past. For CF patients, past smoking was related to higher depression scores, and past drinking was related to higher education and lower social support. For non-CF patients, a history of smoking was associated with being Caucasian and older. For CF patients, a history of drinking was associated with being older and less depressed, and for non-CF patients a history of drinking was associated with higher education and lower social support. Post-transplant 100% of recipients reported abstinence from tobacco, and over 60% reported abstinence from alcohol. Transplant coordinator ratings corroborated that no transplant recipients were using tobacco products or consuming alcohol in an excessive or problematic manner. For both groups, consuming alcohol after transplant was related to lower levels of social support. In conclusion, lung recipients remain abstinent from tobacco, and although over 30% of patients consume alcohol after transplant, it is not at problematic levels. Smoking and drinking behaviors were related to demographic variables, depression, and low social support.

Appraisal and coping as predictors of psychological distress and self-reported physical disability before lung transplantation.

CONTEXT: Certain appraisals and coping strategies have been associated with increased levels of psychological distress and disability in other medical populations, but no study has examined this relationship with patients who are awaiting lung transplantation. OBJECTIVE: To describe the cognitive appraisal and coping strategies used by patients who are pursuing lung transplantation and to evaluate the extent to which these processes are associated with depression, anxiety, and disability. METHODS: This is a cross-sectional design with 160 participants (42.5% men) who have end-stage lung disease and were evaluated for lung transplantation at a large medical center. MEASURES: The outcome variables of depression, anxiety, and physical disability were assessed using the Beck Depression Inventory, Spielberger Trait Anxiety Inventory, and the Sickness Impact Profile, respectively. The predictor variables, coping and appraisal styles, were measured using the COPE and the Stress Threat Questionnaire, respectively. Demographic variables were also assessed. RESULTS: Patients used a variety of adaptive problem- and emotion-focused coping strategies. Hierarchical multiple regressions demonstrated that harm appraisals and the use of particular types of coping styles; namely, disengagement, avoidance, ruminating and venting emotions, low solicitation of emotional support, and suppressing other activities are maladaptive and were uniquely related to psychological distress and disability. CONCLUSIONS: Maladaptive appraisal and coping styles can serve as markers of emotional distress and disability that may help the transplant team identify patients who may benefit from counseling and psychological interventions.

Psychological and educational factors: better predictors of work status than FEV1 in adults with cystic fibrosis.

Now that more individuals with cystic fibrosis (CF) are living into adulthood, vocational attainment is an increasingly important consideration. Work is a key factor in quality of life. The purpose of the present paper was to evaluate the factors that are associated with work status in 183 adults with CF. Approximately half of the participants were working at the time of evaluation, an impressive figure given that the mean forced expired volume in 1 sec (FEV1) was 31.9%. The average number of hours worked was 32.7 hr/week. The majority of individuals were employed in professional, technical, or managerial occupations (accounting, teaching, law, or social work). A third were employed in clerical and sales occupations, and the remaining individuals were employed in a wide range of other occupations (hotel manager, undercover shopper, artist, or dental technician). Interestingly, FEV1 and age did not differentiate between subjects who were working and those who were not. Individuals who were working had significantly lower depression scores and a higher educational level than those who were not working. Future research is needed to determine whether it is the increased socialization and the resulting social support that may come from a work environment, or a reduction in financial stress because of better income and health benefits that helps to explain this difference. Alternatively, work may serve as a distraction from the symptoms of CF. It is likely that those with higher educational levels had more professional jobs that were more easily modified as health declined. Future research needs to assess how career choices are made, and what factors into a patient's decision to keep working.