The Effects of Physical Quality of Life, Time, and Gender on Change in Symptoms of Anxiety and Depression after Liver Transplantation

Abstract

Previous research demonstrated that physical health-related quality of life (HRQOL) improves after liver transplantation, but improvements in mental HRQOL are less dramatic. The aim of this study was to test the effects of physical HRQOL, time post-transplant, and gender on pre- to post-transplant change in anxiety and depression. Longitudinal HRQOL data were prospectively collected at specific times before and after liver transplantation using the SF-36(R) Health Survey (SF-36), Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Anxiety Inventory (BAI). Within-subject change scores were computed to represent the longest follow-up interval for each patient. Multiple regression was used to test the effects of baseline score, time post-transplant, gender, and SF-36 physical component summary scores (PCS) on change in BAI and CES-D scores. About 107 patients (74% male, age=54+/-8 years) were included in the analysis. Time post-transplant ranged 1 to 39 months (mean=9+/-8). Improvement in symptoms of anxiety and depression was greatest in those patients with the most severe pre-transplant symptoms. Significant improvement in symptoms of depression occurred after liver transplant, but the magnitude of improvement was smaller with time suggesting possible relapse of symptoms. Better post-transplant physical HRQOL was associated with a greater reduction in symptoms of anxiety and depression after liver transplantation. This demonstrates clear improvements in post-transplant mental HRQOL and the significant relationships between physical and mental HRQOL.

Knowledge and Daily Living Activities of Post Liver Transplant Clients

“…[48] Moreover, liver transplant recipients are at increased risk of stress due to pre-existing liver failure, functional impairment of graft, rejections and immunosuppression. [49] Based on these findings, it is important for clients to develop strategies to deal with their emotions and to manage stress.…”

Disease Targeted Measures of Health Related Quality of Life (HRQOL) in Patients with Advanced Liver Disease Before and After Liver Transplantation

“…They tested differences in the following domains: liver disease symptoms, concentration, memory, worrying about the disease and sexual problems. Russell et al 2008, with the administration of, SF-36 the Center for Epidemiologic Studies Depression Scale (CES-D), and Beck Anxiety Inventory Scale, observed similar results.…”

“…Studies show that fighting spirit and denial are ways of coping better than the rest, in the sense that facilitate adjustment to illness (Carver, 2005;Russell, 2008).…”

“…There are a number of reliable and valid instruments, however none of them can be considered as the gold standard outcome to be used in all situations. In future studies, more attention should be paid to the QOL outcomes in liver transplant recipients with alcoholic liver disease, hepatocellular carcinoma and those with hepatitis C. Some articles also suggest that female liver transplant recipients should receive special attention (Russell, 2008).…”

Psychologic Evaluation in Liver Transplantation: Assessment of Psychologic Profile of End-Stage Liver Disease Patients Before and After Transplant

“…37,41 Others have suggested a positive correlation between physical and mental health-related quality of life in posttransplant patients. 42 …”