Liver transplantation and adolescence: The role of mental health

Abstract

Young people (YP) with chronic illness have higher rates of mental health problems than the general population, with psychosocial complexity associated with nonadherence and poorer health outcomes. This study aimed to describe the prevalence of anxiety and depression in YP after liver transplantation, with autoimmune liver disease and other chronic liver diseases, identify the factors YP attribute their distress to and the relationship between anxiety/depression, and describe YP's beliefs about their illness and treatment. An electronically administered questionnaire battery was given routinely to YP attending an outpatient liver transition clinic; 187 YP participated, of which 17.7% screened positive for anxiety or depression. There were no significant differences between disease groups. This is significantly higher than the prevalence of common mental health problems in the general adolescent population. Patients most frequently attributed their distress to fatigue, sleep difficulties, financial concerns, problems at work/school, worry, and low self-esteem. Higher levels of depression and anxiety were significantly associated with specific illness and treatment beliefs but not with perceived understanding of illness or treatment control. In conclusion, the increased prevalence of mental health problems in YP and the intertwined nature of these with their physical health outcomes provide evidence that holistic care should be delivered as standard for this age group. Liver Transplantation 22 1544-1553 2016 AASLD.

Health-Related Quality of Life after Pediatric Liver Transplantation: A Qualitative Analysis of the Perspectives of Health Care Providers

“…Barriers to and facilitators of better HRQoL across all domains of HRQoL (physical health, mental health, social functioning, role functioning, and general health perceptions) were reported by HCP, in consistency with previous qualitative studies exploring patients' [12, 17, 18] and their parents' perspectives [17]. HCP perceived gains in physical health and a resumption of normal life activities as a vehicle to better outcomes of HRQoL following pediatric LT.…”

“…Inevitable factors such as the need for long-term immunosuppression and the need for procedural and monitoring interventions were highlighted as key challenges for LT recipients. Additional concerns regarding patients' distress attributed to fears and anxieties around their future health were also identified, in alignment with recently reported high prevalence of mental health problems in young people after LT [18]. …”

Short‐term outcomes of paediatric liver transplant recipients after transition to Adult Healthcare Service

“…The reasons for a later transition in our sample might relate to the difficulty of achieving a steady psychological, biochemical and clinical condition, and to the fact that paediatricians may continue to care for their patients during the adolescents' “invisible early twenties,” a demographic twilight zone in which they are not fully integrated into adult care services . Hames et al demonstrated that solid organ transplant recipients whose transition took place at 16‐25 years of age were more anxious and depressed than those who switched to adult healthcare services between 12 and 18 years old, confirming the vulnerability of this specific age bracket. In another study, anxiety, loneliness and negative thoughts were reported in 53%, 84% and 47%, respectively, of the young adults interviewed (17‐33 years old), and 11% of the sample considered were in the care of psychologists or psychiatrists …”

Patient‐reported outcome measures within pediatric solid organ transplantation: A systematic review

“…The results of this systematic review show that PROMs are being used in the field of pediatric solid organ transplant . However, researchers advise that both generic and disease‐specific instruments are used to conduct a comprehensive evaluation of health status and overall QOL to generate more accurate depictions of a patient's health‐related QOL .…”