The psychosocial correlates of transplant survival.

BACKGROUND: due to the shortage of organs, half of the patients on the waiting list for transplantations die. Clinicians have a duty to identify those patients whom might benefit most. The correlation between psychosocial factors and survival in children who have received lung transplantation for CF has not been investigated. AIMS: to examine: (1) differences in physical, demographic and psychological factors between two groups of children with CF, those who did or did not survive the waiting period for transplantation. (2) Correlations between these factors pre-transplantation and length of survival post transplantation. METHODS: 81 children--mean age 11 years 6 months--and their parents underwent semi-structured standardised interviews and completed standardised instruments prior to being placed on the transplantation waiting list. The following domains were measured: child's disability, psychiatric status and self-esteem; quality of marital relationship and parental psychiatric status; and family attitudes and functioning. RESULTS: 20% of the children on the waiting list had a psychiatric disorder and 60% of the parents scored within the psychiatric disorder range. One third of the parents had marital difficulties, and 20% of the families showed chaotic functioning. Only half of the children survived to receive transplantation. Survivors and non-survivors were comparable with regard to all psychological measures. A follow up of the transplanted children, ranging from 3 to 156 months post-transplantation, produced a group of nine survivors and 30 non-survivors. Only two pre-transplant factors showed a significant association with length of survival after transplantation. Severe physical disability was associated with longer survival (P=0.01), and parental hostility to partner was associated with a shortened life span (P=0.04). No other factors were significantly associated with length of survival. CONCLUSION: there is no evidence to suggest that adverse psychosocial factors should be used as a contraindication to transplantation.

Psychological state and quality of life in patients having behavioral treatment (biofeedback) for intractable constipation.

OBJECTIVE: Behavioral techniques, including biofeedback, improve symptoms in a majority of patients with intractable idiopathic constipation. However, it is unknown whether there is also improvement in patients' psychological well-being and quality of life (QOL). It is also unknown whether psychological or QOL factors can be used to predict the response to treatment. We aimed to assess these factors prospectively. METHODS: Thirty-one consecutive patients (median age 36 yr) receiving biofeedback retraining for idiopathic constipation were studied. A bowel symptom record, the General Health Questionnaire-28 (GHQ-28) (n = 31) and Hospital Anxiety and Depression Scale (n = 20), both psychological measures, and the Short Form-36 (SF-36) (n = 22), a generic QOL measure, were recorded before and after treatment. RESULTS: Twenty-two of the patients felt subjectively symptomatically improved. When considering all patients, treatment resulted in decreased depression (p < 0.05), anxiety (p < 0.05), and somatic symptoms (p < 0.01) (psychological measures: GHQ-28), and improved general health (p < 0.05) and vitality (p < 0.05) (QOL measures: SF-36). Patients who improved symptomatically showed significantly higher scores on the GHQ-28 and SF-36, in contrast to the unchanged scores in patients who did not symptomatically improve. Pretreatment GHQ-28 did not predict who would benefit from treatment, but patients in whom pain, emotional problems, or low vitality interfered with daily living (SF-36 pain subscales) were significantly (p < 0.05) less likely to respond to treatment. CONCLUSIONS: The symptomatic improvement produced by biofeedback in constipated patients is associated with improved psychological state and QOL. Some of the psychological morbidity in these patients is reversible. QOL parameters may be useful for predicting a likely response to treatment.