A Multisite Study on Using Symptom-Targeted Interventions to Improve Mental Health Outcomes of Solid Organ Transplant Patients.

INTRODUCTION: Depression and anxiety are common affective experiences during the first year following a solid organ transplant. This study examined the degree to which an evidenced-based clinical intervention implemented by social workers-Symptom Targeted Intervention-can alter self-reported depression and anxiety in heart, kidney, liver, and lung transplant recipients. RESEARCH QUESTIONS: This investigation explored 2 questions: (1) Can symptom-targeted interventions significantly reduce posttransplant recipients' self-reported depression and anxiety at the conclusion of treatment and at 1-month follow-up? and (2) Does the response differ by gender? DESIGN: A 1-group pretest-posttest design with a 1-month follow-up was used to test for changes in anxiety and depression after transplantation. Forty-eight patients at 2 US transplant centers were enrolled between January 2016 and May 2017. Data were collected using an online platform and analyzed to assess for differences over time and by gender. RESULTS: Anxiety decreased significantly between pretest and posttest using the General Anxiety Disorder-2 (P < .05). Comparisons by gender indicated that women had a significant decrease in anxiety between pretest and posttest (P < .001); however, there was no significant decrease in anxiety for men. Analyses by gender and time yielded no significant differences for depression. DISCUSSION: Symptom-targeted interventions have the potential to reduce anxiety in solid organ transplant patients and enhance their psychosocial adjustment after surgery.

Symptom targeted intervention webinar trainings: feedback from participants.

Professional trainings through the use of webinar format are widely used, but participant feedback is seldom studied. In the spring of 2013, 83 nephrology social workers participated in weekly webinar trainings to learn how to implement Symptom Targeted Intervention (STI) into their clinical practice. At the end of the project, participants were asked to complete an online questionnaire to provide feedback on the perceived value and effectiveness of the trainings. Sixty-eight participants completed the questionnaire. The results indicate that social workers found the webinar trainings to be very useful and wanted the trainings to continue beyond the project. Based on participant feedback, clinical training and case presentation through the use of ongoing webinars is a useful education modality for nephrology professionals, but more research is indicated to evaluate how best to utilize webinars to maximize learning.

Part 2. The promise of symptom-targeted intervention to manage depression in dialysis patients: improving mood and quality of life outcomes.

The Practice Outcome Evaluation of using Symptom Targeted Intervention (STI) to manage depressed mood in dialysis patients reviewed social worker experiences and observations using STI. The evaluation was guided by the following questions: 1. What is the feasibility of STI in nephrology social work? 2. What is nephrology social worker comfort level with clinical assessment, intervention, and tracking? 3. What is the potential efficacy of STI on reducing depression? Initial results suggest that STI enhances existing nephrology social work skills in identifying, treating, and tracking outcomes of patient issues requiring clinical intervention. Most social workers spent 1.5 hours over a six-week period using STI techniques to address symptoms of depression with a patient. This rather short period of intervention led to a reported improvement in PCS and MCS scores of 51.6% and 61.3% of patients, respectively, and improvement in CES-D scores in 72.1% of patients. While this practice outcome evaluation is limited by how social workers were selected and the small number of patients, it demonstrates options for further study of the efficacy of STI in reducing depression. The brief time invested in training holds promise for impacting nephrology social work and improving patient and dialysis clinics' outcomes.

The promise of symptom-targeted intervention to manage depression in dialysis patients.

Research with tens of thousands of dialysis patients has established a link between depression, health-related quality of life scores, survival, and hospitalizations. In fact, physical and mental functioning scores are as predictive of death and hospitalization as Kt/V and albumin. Some models for managing depression in the dialysis clinic have been developed. These models address barriers to accessing community mental health services. They also promote collaboration between the nephrology social worker and nephrologist to assurethat patients receive counseling and/or antidepressant medications when they need them. Part 1 of this article will introduce a promising new method designed for nephrology social workers to help patients manage depression. This method, known as symptom-targeted intervention (STI), can be used in brief intervals with patients while they are receiving dialysis treatments to help reduce depressive symptoms and improve quality of life. The second part of this article, which will appear in the June issue of Nephrology News & Issues, will report the outcomes of a 17-state pilot study in which more than 45 nephrology social workers used brief, focused STI methods with more than 75 patients in the dialysis clinic setting. The impact of STI on depression and quality of life in this sample will be explored as well as how those outcomes may impact hospitalizations, improve patient survival, and contain costs in a bundled reimbursement environment.