Stilley Carol S, Lawrence Kathy, Bender Ann, Olshansky Ellen, Webber Steven A, Dew Mary Amanda
School of Nursing, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Pediatr Transplant. 2006 May;10(3):323-30. doi: 10.1111/j.1399-3046.2005.00473.x.
Pediatric transplant (txp) teams note high rates of non-adherence and risky behaviors linked to morbidity and mortality among adolescent and young adult recipients. Clinicians and parents alike report symptoms of social immaturity and failure to appreciate consequences of risky behavior; relationships between the two have not been studied in this population.
This two-phase mixed method study examined adherence, high-risk behaviors, and maturity in a sample of 27 heart recipients, aged 15-31, who underwent transplantation in childhood or adolescence at Children's Hospital of Pittsburgh. All subjects completed a projective ego development measure and a questionnaire about adherence to the post-txp regimen. Nine recipients, purposely selected for good or poor adherence according to criteria determined by the transplant team and matched on age, participated in phase 2 qualitative interviews and mood assessments.
Sixty-three percent of the phase 1 sample missed medications, 67% missed appointments, 11% smoked, 37% had difficulty with diet, 89% exercised infrequently, 33% had tattoos, 26% had more than two body piercings, and 11% used street drugs. Six themes and a core construct of maturity were identified with qualitative methodology. Poor adherers were less mature on every theme and consistently scored at a less mature level on the projective measure of ego development. Chronological age was not related to the level of maturity in qualitative or projective data. Most interview subjects reported high levels of anxiety, and two reported clinically significant levels of depression and anger; mood was not related to adherence.
Non-adherence and high-risk behaviors are prevalent among adolescent and young adult heart recipients. Level of maturity appears to be associated with ability to adhere to the treatment regimen and avoid high-risk behaviors.
儿科移植团队注意到，青少年及年轻成人移植受者中与发病率和死亡率相关的不依从率和危险行为发生率很高。临床医生和家长都报告了社交不成熟的症状以及对危险行为后果认识不足的情况；尚未对该人群中这两者之间的关系进行研究。
这项两阶段混合方法研究对27名年龄在15至31岁之间、曾在匹兹堡儿童医院接受儿童期或青少年期心脏移植的受者样本进行了依从性、高危行为和成熟度调查。所有受试者均完成了一项投射性自我发展测评以及一份关于移植后治疗方案依从性的问卷。根据移植团队确定的标准，特意挑选出9名依从性好或差的受者，这些受者年龄匹配，参与了第二阶段的定性访谈和情绪评估。
第一阶段样本中，63%的人漏服药物，67%的人错过预约，11%的人吸烟，37%的人在饮食方面有困难，89%的人很少锻炼，33%的人有纹身，26%的人有两处以上身体穿孔，11%的人使用街头毒品。采用定性方法确定了六个主题和一个成熟度的核心结构。依从性差的人在每个主题上都不太成熟，并且在自我发展的投射性测评中始终得分较低。实际年龄与定性或投射性数据中的成熟度水平无关。大多数访谈对象报告焦虑程度较高，两人报告有临床显著水平的抑郁和愤怒；情绪与依从性无关。
青少年及年轻成人心脏移植受者中不依从和高危行为很普遍。成熟度水平似乎与坚持治疗方案和避免高危行为的能力有关。
