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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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