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

Published online by Cambridge University Press:  09 July 2009

M. A. Dew ,
R. G. Simmons ,
L. H. Roth ,
H. C. Schulberg ,
M. E. Thompson ,
J. M. Armitage  and
B. P. Griffith
M. A. Dew*
Affiliation:
Departments of Psychiatry, Epidemiology, Psychology, Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
R. G. Simmons
Affiliation:
Departments of Psychiatry, Epidemiology, Psychology, Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
L. H. Roth
Affiliation:
Departments of Psychiatry, Epidemiology, Psychology, Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
H. C. Schulberg
Affiliation:
Departments of Psychiatry, Epidemiology, Psychology, Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
M. E. Thompson
Affiliation:
Departments of Psychiatry, Epidemiology, Psychology, Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
J. M. Armitage
Affiliation:
Departments of Psychiatry, Epidemiology, Psychology, Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
B. P. Griffith
Affiliation:
Departments of Psychiatry, Epidemiology, Psychology, Medicine and Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
*
1Address for correspondence: Dr M. A. Dew, Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara street, Pittsburgh, PA 15213, USA
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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.

Type
Original Articles
Information
Psychological Medicine , Volume 24 , Issue 4 , November 1994 , pp. 929 - 945
Copyright
Copyright © Cambridge University Press 1994

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References

Billings, A. G. & Moos, R. H. (1984). Coping, stress, and social resources among adults with unipolar depression. Journal of Personality and Social Psychology 46, 877–891.CrossRefGoogle ScholarPubMed
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, 435–440.CrossRefGoogle Scholar
Brown, G. W. & Harris, T. (1978). Social Origins of Depression: A Study of Psychiatric Disorder in Women. Tavistock: London.Google Scholar
Brown, G. W., Bifulco, A. & Andrews, B. (1990). Self-esteem and depression. III. Aetiological issues. Social Psychiatry and Psychiatric Epidemiology 25, 235–243.CrossRefGoogle ScholarPubMed
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. 389–422. W. B. Saunders: Philadelphia.Google Scholar
Cavanaugh, S. (1984). Diagnosing depression in the hospitalized patient with chronic medical illness. Journal of Clinical Psychiatry 45, 13–16.Google ScholarPubMed
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, 249–265.CrossRefGoogle ScholarPubMed
Cohen, F. (1987). Measurement of coping. In Stress and Health: Issues in Research Methodology (ed. Kasl, S. V. and Cooper, C. L.), pp. 283–305. Wiley: New York.Google Scholar
Cooper, D. K. C., Lanza, R. P. & Barnard, C. N. (1984). Noncompliance in heart transplant recipients. Heart Transplantation 3, 248–253.Google Scholar
Coyne, J. C. & Downey, G. (1991). Social factors and psychopathology: stress, social support and coping processes. Annual Review of Psychology 42, 401–425.CrossRefGoogle ScholarPubMed
Derogatis, L. R. (1983). SCL-90 R Administration, Scoring and Procedures Manual-II 2nd edn.Clinical Psychometrics Research: Towson, MD.Google Scholar
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, 737–744.CrossRefGoogle ScholarPubMed
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, 3073–3076.Google ScholarPubMed
Dew, M. A., Bromet, E. J. & Penkower, L. (1992). Mental health effects of job loss in women. Psychological Medicine 22, 751–764.CrossRefGoogle ScholarPubMed
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, 145–152.CrossRefGoogle ScholarPubMed
Dohrenwend, B. P. (1990). Socioeconomic status (SES) and psychiatric disorders: are the issues still compelling? Social Psychiatry and Psychiatric Epidemiology 25, 41–47.CrossRefGoogle ScholarPubMed
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. 1–27. Prodist: New York.Google Scholar
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, 205–229.CrossRefGoogle ScholarPubMed
Evans, R. W. (1982). Economic and social costs of heart transplantation. Heart Transplantation 1, 243–251.Google ScholarPubMed
Evans, R. W. (1987). The economics of heart transplantation. Circulation 75, 63–76.CrossRefGoogle ScholarPubMed
Finlay-Jones, R. & Brown, G. W. (1981). Types of stressful life event and the onset of anxiety and depressive disorders. Psychological Medicine 11, 803–815.CrossRefGoogle ScholarPubMed
Freeman, A. M., Folks, D. G., Sokol, R. S. & Fahs, J. J. (1988). Cardiac transplantation: clinical correlates of psychiatric outcome. Psychosomatics 29, 47–54.CrossRefGoogle ScholarPubMed
Frierson, R. L. & Lippmann, S. T. (1987). Heart transplant candidates rejected on psychiatric indications. Psychosomatics 28, 347–355.CrossRefGoogle ScholarPubMed
Goldstein, M. G. & Niaura, R. (1992). Psychological factors affecting physical condition: cardiovascular disease literature review. Psychosomatics 33, 134–145.CrossRefGoogle ScholarPubMed
Grieco, A. & Long, C. J. (1984). Investigation of the Karnofsky Performance Status as a measure of quality of life. Health Psychology 3, 129–142.CrossRefGoogle ScholarPubMed
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, 393–398.CrossRefGoogle ScholarPubMed
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. 51–55. R. G. Landes: Austin, TX.Google Scholar
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. 191–205. Columbia University Press: New York.Google Scholar
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, 599–606.Google Scholar
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, 541–548.Google ScholarPubMed
Kessler, R. C., Price, R. H. & Wortman, C. B. (1985). Social factors in psychopathology. Annual Review of Psychology 36, 531–572.CrossRefGoogle ScholarPubMed
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.Google ScholarPubMed
Lough, M. E. (1988). Quality of life for heart transplant recipients. Journal of Cardiovascular Nursing 2, 11–22.CrossRefGoogle ScholarPubMed
Lunde, D. T. (1969). Psychiatric complications of heart transplants. American Journal of Psychiatry 126, 369–373.CrossRefGoogle ScholarPubMed
McAleer, M. J., Copeland, J., Fuller, J. & Copeland, J. G. (1985). Psychological aspects of heart transplantation. Heart Transplantation 3, 133–144.Google Scholar
Mai, F. M., McKenzie, F. N. & Kostuk, W. J. (1986). Psychiatric aspects of heart transplantation: preoperative evaluation and postoperative sequelae. British Medical Journal 292, 311–313.CrossRefGoogle ScholarPubMed
Mai, F. M., McKenzie, F. N. & Kostuk, W. J. (1990). Psychosocial adjustment and quality of life following heart transplantation. Canadian Journal of Psychiatry 35, 223–227.CrossRefGoogle ScholarPubMed
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, 127–134.CrossRefGoogle ScholarPubMed
Mishel, M. H. & Murdaugh, C. L. (1987). Family adjustment to heart transplantation. Nursing Research 36, 332–338.CrossRefGoogle ScholarPubMed
Moos, R. H. (1975). Evaluating Correctional and Community Settings. John Wiley & Sons Inc.: New York.Google Scholar
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. 212–230. Free Press: New York.Google Scholar
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, 753–760.CrossRefGoogle ScholarPubMed
Pearlin, L. & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior 19, 2–21.CrossRefGoogle ScholarPubMed
Penkower, L., Bromet, E. J. & Dew, M. A. (1988). Husbands' layoff and wives' mental health: a prospective analysis. Archives of General Psychiatry 45, 994–1000.CrossRefGoogle ScholarPubMed
Penn, I., Bunch, D., Olenik, D. & Abouna, G. (1971). Psychiatric experience with patients receiving renal and hepatic transplants. Seminars in Psychiatry 3, 133–144.Google ScholarPubMed
Phipps, L. (1991). Psychiatric aspects of heart transplantation. Canadian Journal of Psychiatry 36, 563–568.CrossRefGoogle ScholarPubMed
Radloff, L. S. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement 1, 385–401.CrossRefGoogle Scholar
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, 444–450.CrossRefGoogle ScholarPubMed
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, 949–958.CrossRefGoogle ScholarPubMed
Rosenberg, M. (1965). Society and the Adolescent Self-Image. Princeton University Press: Princeton, NJ.CrossRefGoogle Scholar
Rosenthal, R. & Rosnow, R. L. (1985). Contrast Analysis: Focused Comparison in the Analysis of Variance. Cambridge University Press: New York.Google Scholar
Shapiro, P. A. & Kornfeld, D. A. (1989). Psychiatric outcome of heart transplantation. General Hospital Psychiatry 11, 352–357.CrossRefGoogle ScholarPubMed
Simmons, R. G. & Anderson, C. R. (1982). Related donors and recipients five to nine years posttransplant. Transplantation Proceedings 14, 9–12.Google Scholar
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.Google Scholar
Simmons, R. G., Abress, L. & Anderson, C. R. (1988). Quality of life after kidney transplantation. Transplantation 45, 415–421.CrossRefGoogle ScholarPubMed
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, 15–28.CrossRefGoogle Scholar
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, 624–629.CrossRefGoogle ScholarPubMed
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, 919–925.CrossRefGoogle ScholarPubMed
Thompson, M. E. (1989). Recipient selection and assessment: indications for transplantation. In Heart and Heart-Lung Transplantation (ed. Wallwork, J.), pp. 87–100. W. B. Saunders Co.: Philadelphia.Google Scholar
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, 317–331.Google Scholar
Waring, E. (1985). Measurement of intimacy: conceptual and methodological issues in studying close relationships. Psychological Medicine 15, 9–14.CrossRefGoogle ScholarPubMed
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, 243–247.Google Scholar
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, 1397–1403.CrossRefGoogle ScholarPubMed