Psychosocial predictors of vulnerability to distress in the year following heart transplantation

Abstract

SynopsisThis study examines psychological symptomatology in a cohort of 72 heart transplant recipients followed longitudinally during their first year post-transplant. In keeping with research on other domains of life stressors and illnesses, a central study goal was to identify pre-transplant and perioperative psychosocial factors associated with increased vulnerability to, and maintenance of, elevated psychological distress levels post-transplant. Average anxiety and depression levels, but not anger–hostility symptoms, were substantially elevated in the early post-transplant period, relative to normative data. Average symptom levels improved significantly over time, although one-third of the sample continued to have high distress levels at all follow-up assessments. Recipients with any of seven psychosocial characteristics at initial interview were particularly susceptible to continued high average distress levels over time: a personal history of psychiatric disorder prior to transplant; younger age; lower social support from their primary family caregiver; exposure to recent major life events involving loss; poor self-esteem; a poor sense of mastery; and use of avoidance coping strategies to manage health problems. Recipients without such factors showed improvement in average distress levels across the assessment period. These effects were stronger for anxiety than depressive symptoms, with the exception of a sizeable relationship between loss events and subsequent depression. The findings suggest that clinical interventions designed to minimize prolonged emotional distress post-transplant need to be closely tailored to heart recipients' initial psychosocial assets and liabilities.

Hope, mood states and quality of life in female heart transplant recipients

“…Previous researchers have shown similar findings. Dew and colleagues 1 found that anxiety and depression levels rise in the early post-transplant period but rapidly decrease over time in 67% of the patients. In a more recent study, Dew et al 4 documented poor psychologic adjustment to heart transplantation as a major contributor to reduced QOL and increased physical morbidity beyond the first 12 to 18 months after transplantation.…”

“…results in increased distress and anxiety, [1][2][3][4] and a number of patients find themselves confronted with the difficult and unexpected task of adapting to a chronic physical condition after the surgery. 5 For this reason, care of the heart transplant patient has evolved from focusing solely on survival to improving emotional well-being and quality of life (QOL).…”

Physical and psychological attributes of fatigue in female heart transplant recipients

“…Likewise, studies on the effect of OHT on functional and psychologic outcomes show that, overall, OHT recipients report dramatic improvements in functional outcomes but continue to report psychologic distress several years after OHT surgery. 4,5 More recently, investigators 6,7 have judiciously examined factors associated with psychologic distress and disorders among OHT survivors that have led to a better understanding of OHT survivorship. However, few investigators have examined factors associated with fatigue among OHT recipients after surgery.…”

Meaning and life purpose: the perspectives of post-transplant women

“…[1][2][3][4] persons who undergo heart transplant experience increased psychological distress related both to postoperative physiological changes and to adjustment to a posttransplant treatment regimen fraught with side effects. 5 Recently, researchers have suggested that the need to cope with the physical loss of a heart and acceptance of a donor heart may be antecedent to feelings of psychological distress.…”