Skip to main content Accessibility help
×
Home

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

  • M. A. Dew (a1), R. G. Simmons (a1), L. H. Roth (a1), H. C. Schulberg (a1), M. E. Thompson (a1), J. M. Armitage (a1) and B. P. Griffith (a1)...

Synopsis

This 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.

Copyright

Corresponding author

1Address for correspondence: Dr M. A. Dew, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara street, Pittsburgh, PA 15213, USA

References

Hide All
Billings, A. G. & Moos, R. H. (1984). Coping, stress, and social resources among adults with unipolar depression. Journal of Personality and Social Psychology 46, 877891.
Bromet, E. J., Dunn, L. O., Connell, M. M., Dew, M. A. & Schulberg, H. C. (1986). Longterm reliability of lifetime major depression in a community sample. Archives of General Psychiatry 43, 435440.
Brown, G. W. & Harris, T. (1978). Social Origins of Depression: A Study of Psychiatric Disorder in Women. Tavistock: London.
Brown, G. W., Bifulco, A. & Andrews, B. (1990). Self-esteem and depression. III. Aetiological issues. Social Psychiatry and Psychiatric Epidemiology 25, 235243.
Caine, H. & O'Brien, V. (1989). Quality of life and psychological aspects of heart transplantation. In Heart and Heart-Lung Transplantation (ed. Wallwork, J.), pp. 389422. W. B. Saunders: Philadelphia.
Cavanaugh, S. (1984). Diagnosing depression in the hospitalized patient with chronic medical illness. Journal of Clinical Psychiatry 45, 1316.
Christensen, A. J., Turner, C. W., Slaughter, J. R. & Holman, J. M. Jr. (1989). Perceived family support as a moderator: psychological well-being in end-stage renal disease. Journal of Behaviour Medicine 12, 249265.
Cohen, F. (1987). Measurement of coping. In Stress and Health: Issues in Research Methodology (ed. Kasl, S. V. and Cooper, C. L.), pp. 283305. Wiley: New York.
Cooper, D. K. C., Lanza, R. P. & Barnard, C. N. (1984). Noncompliance in heart transplant recipients. Heart Transplantation 3, 248253.
Coyne, J. C. & Downey, G. (1991). Social factors and psychopathology: stress, social support and coping processes. Annual Review of Psychology 42, 401425.
Derogatis, L. R. (1983). SCL-90 R Administration, Scoring and Procedures Manual-II 2nd edn.Clinical Psychometrics Research: Towson, MD.
Dew, M. A., Ragni, M. V. & Nimorwicz, P. (1990). Infection with Human Immunodeficiency Virus and vulnerability to psychiatric distress: a study of men with hemophilia. Archives of General Psychiatry 47, 737744.
Dew, M. A., Harris, R. C., Simmons, R. G., Roth, L. H., Armitage, J. M. & Griffith, B. P. (1991). Quality of life advantages of FK 506 vs. conventional immunosuppressive drug therapy in cardiac transplantation. Transplantation Proceedings 23, 30733076.
Dew, M. A., Bromet, E. J. & Penkower, L. (1992). Mental health effects of job loss in women. Psychological Medicine 22, 751764.
Dew, M. A., Kormos, R. L., Roth, L. H., Armitage, J. M., Pristas, J. M., Harris, R. C., Capretta, C. & Griffith, B. P. (1993). Life quality in the era of bridging to cardiac transplantation. ASAIO (American Society for Artificial Internal Organs) Journal 39, 145152.
Dohrenwend, B. P. (1990). Socioeconomic status (SES) and psychiatric disorders: are the issues still compelling? Social Psychiatry and Psychiatric Epidemiology 25, 4147.
Dohrenwend, B. S. & Dohrenwend, B. P. (1981). Life stress and illness. In Stressful Life Events and Their Contexts (ed. Dohrenwend, B. S. and Dohrenwend, B. P.), pp. 127. Prodist: New York.
Dohrenwend, B. S., Krasnoff, L., Askenasy, A. R. & Dohrenwend, B. P. (1978). Exemplification of a method for scaling life events: the PERI Life Events Scale. Journal of Health and Social Behavior 19, 205229.
Evans, R. W. (1982). Economic and social costs of heart transplantation. Heart Transplantation 1, 243251.
Evans, R. W. (1987). The economics of heart transplantation. Circulation 75, 6376.
Finlay-Jones, R. & Brown, G. W. (1981). Types of stressful life event and the onset of anxiety and depressive disorders. Psychological Medicine 11, 803815.
Freeman, A. M., Folks, D. G., Sokol, R. S. & Fahs, J. J. (1988). Cardiac transplantation: clinical correlates of psychiatric outcome. Psychosomatics 29, 4754.
Frierson, R. L. & Lippmann, S. T. (1987). Heart transplant candidates rejected on psychiatric indications. Psychosomatics 28, 347355.
Goldstein, M. G. & Niaura, R. (1992). Psychological factors affecting physical condition: cardiovascular disease literature review. Psychosomatics 33, 134145.
Grieco, A. & Long, C. J. (1984). Investigation of the Karnofsky Performance Status as a measure of quality of life. Health Psychology 3, 129142.
Helzer, J. E., Robins, L. N., Croughan, J. L. & Welner, A. (1981). Renard Diagnostic Interview: its reliability and procedural validity with physicians and lay interviewers. Archives of General Psychiatry 38, 393398.
Hunt, S. (1993). Long-term follow-up and rehabilitation of heart transplant patients. In Heart and Lung Transplantation 2000 (ed. Kaye, M. P. and O'Connell, J. B.), pp. 5155. R. G. Landes: Austin, TX.
Karnofsky, D. A. & Burchenal, J. H. (1949). The clinical evaluation of chemotherapeutic agents in cancer. In Evaluation of Chemotherapeutic Agents (ed. Macleod, C. M.), pp. 191205. Columbia University Press: New York.
Kaye, M. P. (1992). The Registry of the International Society for Heart and Lung Transplantation, Ninth Official Report – 1992. Journal of Heart and Lung Transplantation 11, 599606.
Kaye, M. P. (1993). The Registry of the International Society for Heart and Lung Transplantation: Tenth Official Report – 1993. Journal of Heart and Lung Transplantation 12, 541548.
Kessler, R. C., Price, R. H. & Wortman, C. B. (1985). Social factors in psychopathology. Annual Review of Psychology 36, 531572.
Kuhn, W. F., Myers, B., Brennan, A. F., Davis, M. H., Lippmann, S. B., Gray, L. A. & Pool, G. E. (1988). Psychopathology in heart transplant candidates. Heart Transplantation 7, 223.
Lough, M. E. (1988). Quality of life for heart transplant recipients. Journal of Cardiovascular Nursing 2, 1122.
Lunde, D. T. (1969). Psychiatric complications of heart transplants. American Journal of Psychiatry 126, 369373.
McAleer, M. J., Copeland, J., Fuller, J. & Copeland, J. G. (1985). Psychological aspects of heart transplantation. Heart Transplantation 3, 133144.
Mai, F. M., McKenzie, F. N. & Kostuk, W. J. (1986). Psychiatric aspects of heart transplantation: preoperative evaluation and postoperative sequelae. British Medical Journal 292, 311313.
Mai, F. M., McKenzie, F. N. & Kostuk, W. J. (1990). Psychosocial adjustment and quality of life following heart transplantation. Canadian Journal of Psychiatry 35, 223227.
Maricle, R. A., Burt, A. R. & Hosenpud, J. D. (1991). Correlations of cardiac function and SCL-90R in heart transplantation candidates. International Journal of Psychiatry in Medicine 21, 127134.
Mishel, M. H. & Murdaugh, C. L. (1987). Family adjustment to heart transplantation. Nursing Research 36, 332338.
Moos, R. H. (1975). Evaluating Correctional and Community Settings. John Wiley & Sons Inc.: New York.
Moos, R. H. & Billings, A. G. (1982). Conceptualizing and measuring coping resources and processes. In Handbook of Stress (ed. Goldberger, L. and Breznitz, S.), pp. 212230. Free Press: New York.
Paykel, E. S., Myers, J. K., Dienelt, M. N., Klerman, G. L., Lindenthal, J. J. & Pepper, M. P. (1969). Life events and depression: a controlled study. Archives of General Psychiatry 21, 753760.
Pearlin, L. & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior 19, 221.
Penkower, L., Bromet, E. J. & Dew, M. A. (1988). Husbands' layoff and wives' mental health: a prospective analysis. Archives of General Psychiatry 45, 9941000.
Penn, I., Bunch, D., Olenik, D. & Abouna, G. (1971). Psychiatric experience with patients receiving renal and hepatic transplants. Seminars in Psychiatry 3, 133144.
Phipps, L. (1991). Psychiatric aspects of heart transplantation. Canadian Journal of Psychiatry 36, 563568.
Radloff, L. S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385401.
Riether, A. M., Smith, S. L., Lewison, B. J., Cotsonis, G. A. & Epstein, C. M. (1992). Quality-of-life changes and psychiatric and neurocognitive outcome after heart and liver transplantation. Transplantation 54, 444450.
Robins, L. N., Helzer, J. E., Weissman, M. M., Orvaschel, H., Gruenberg, E., Burke, J. D. & Regier, D. A. (1984). Lifetime prevalence of specific psychiatric disorders in three sites. Archives of General Psychiatry 41, 949958.
Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton University Press: Princeton, NJ.
Rosenthal, R. & Rosnow, R. L. (1985). Contrast Analysis: Focused Comparison in the Analysis of Variance. Cambridge University Press: New York.
Shapiro, P. A. & Kornfeld, D. A. (1989). Psychiatric outcome of heart transplantation. General Hospital Psychiatry 11, 352357.
Simmons, R. G. & Anderson, C. R. (1982). Related donors and recipients five to nine years posttransplant. Transplantation Proceedings 14, 912.
Simmons, R. G., Marine, S. K. & Simmons, R. L. (1987). Gift of Life: The Effect of Organ Transplantation on Individual, Family, and Societal Dynamics. Transaction Books: New Brunswick, CT.
Simmons, R. G., Abress, L. & Anderson, C. R. (1988). Quality of life after kidney transplantation. Transplantation 45, 415421.
Spanier, G. B. (1976). Measuring dyadic adjustment: new scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family 38, 1528.
Spitzer, R. L., Williams, J. B. W., Gibbon, M. & First, M. B. (1992). The Structured Clinical Interview for DSM-III-R (SCID) I: history, rationale and description. Archives of General Psychiatry 49, 624629.
Stevenson, L. W., Hamilton, M. A. & Tillisch, J. H. (1991). Decreasing survival benefit from cardiac transplantation for out-patients as the waiting list lengthens. Journal of the American College of Cardiology 18, 919925.
Thompson, M. E. (1989). Recipient selection and assessment: indications for transplantation. In Heart and Heart-Lung Transplantation (ed. Wallwork, J.), pp. 87100. W. B. Saunders Co.: Philadelphia.
Wallwork, J. & Caine, N. (1985). A comparison of the quality of life of cardiac transplant patients and coronary artery bypass graft patients before and after surgery. Quality of Life and Cardiovascular Care Sept/Oct, 317331.
Waring, E. (1985). Measurement of intimacy: conceptual and methodological issues in studying close relationships. Psychological Medicine 15, 914.
Watts, D., Kirklin, J. K., Freeman, A. M., McVay, R., McGriffin, D. G. & Karp, R. B. (1984). Psychiatric aspects of cardiac transplantation. Heart Transplantation 3, 243247.
Weissman, M. M., Kidd, K. K. & Prusoff, B. A. (1982). Variability in rates of affective disorders in relatives of depressed and normal probands. Archives of General Psychiatry 39, 13971403.

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

  • M. A. Dew (a1), R. G. Simmons (a1), L. H. Roth (a1), H. C. Schulberg (a1), M. E. Thompson (a1), J. M. Armitage (a1) and B. P. Griffith (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed