Negative affect and self-agency’s association with immunosuppressant adherence in organ transplant: A meta-analysis.

Abstract

In organ transplant, prevalence estimates of negative affect (e.g., depressive symptoms) are higher than in the general population and self-agency is required for successful regimen selfmanagement. Nonetheless, the roles of these psychological factors for immunosuppressant adherence in this population remain unclear. Method: Meta-analytic techniques were used to determine the associations between negative affect and self-agency with adherence and to identify moderators of these associational effect sizes (ES). Results: Across 50 studies and 46,106 adult organ recipients, there is a small negative association between negative affect and adherence (mean weighted ES: r ϭ Ϫ.14, p Ͻ .001; 95% confidence interval, CI [Ϫ.175, Ϫ.096]) and a small positive association between self-agency and adherence (ES: r ϭ .17, p Ͻ .001; 95% CI [.094, .251]). Studies conducted outside of Europe and North America, assessing illness-specific negative affect and utilizing questionnaire adherence measures, and studies of better quality were associated with a larger ES, explaining 54% of the heterogeneity in the negative affect and adherence association. For the association between self-agency and adherence, a higher percentage of females and medication-specific self-agency were associated with a larger ES, explaining 34% of the heterogeneity. Conclusions: By elucidating overlooked trends in the existing literature for the associations between negative affect and self-agency with adherence, the current meta-analyses clarify previously contradicting findings in organ transplant. The findings also shed light on factors contributing to the existing variability and highlight the importance of careful consideration of methodology in studies of adherence postorgan transplant.

Defining Self-Management for Solid Organ Transplantation Recipients: A Mixed Method Study

“…In the context of our secondary analysis, we identified 41 records from a total pool of included 742 scoping review records contained definitions. Screening of these records resulted in eight “original” definitions [ 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Sixty three records were identified through secondary sources [ 20 , 21 , 23 , 25 , 26 , 28 , 30 , 31 , 33 , 34 , 35 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 ,…”

“…A single definition focused on an aspect of SM medication adherence [ 44 ], and the remainder focused on all aspects. Definitions focused on one or multiple transplant organ types: heart [ 46 , 49 , 50 ], liver [ 45 , 48 , 49 ], kidney [ 44 , 45 , 49 , 51 ], pancreas [ 49 ], and lung [ 49 ] ( Supplementary File S2 ). Amongst the definition publications, seven of the eight are quantitative studies, with one qualitative [ 51 ].…”

“…Frank-Bader et al presented the results of an intervention on an interdisciplinary patient education programme. All the other quantitative studies were either predictive—identifying negative outcomes using patient characteristics [ 46 , 47 , 49 ] and risk factors [ 44 , 46 ], or described correlations between outcomes and patient symptoms/characteristics [ 48 , 49 , 50 ]. Ghadami et al’s qualitative study explored the defining experiences of education for patients, partly, in relation to reaching a state of self-management [ 51 ].…”

“…A further example is the definition from Ko et al [ 48 ] did not cite Bratzke [ 23 ] alongside Lindsay [ 78 ] and Morris et al [ 86 ]. Demian et al [ 49 ] refer to tasks of SM and include adherence to the medication regimen; however, the authors omit dimensions of the SM concepts present in Adams et al [ 52 ], including self-management support and SM education.…”

Adherence in transplantation

“…Psychological issues like depression and negative affect are seen in higher rates in transplant patients than in the general public. A meta-analysis of 50 studies found that negative affect was associated with nonadherence, whereas self-agency was associated with better adherence [31 ▪ ]. In a sample of pediatric transplant patients, posttraumatic stress symptoms were associated with nonadherence in adolescent liver transplant recipients [32 ▪ ].…”