Annema Coby, Roodbol Petrie F, Van den Heuvel Edwin R, Metselaar Herold J, Van Hoek Bart, Porte Robert J, Ranchor Adelita V
Department of Nursing Research, University Medical Center Groningen, University of Groningen, the Netherlands.
Department of Mathematics and Computer Science, Eindhoven University of Technology, the Netherlands.
Br J Health Psychol. 2017 Sep;22(3):481-501. doi: 10.1111/bjhp.12241. Epub 2017 May 5.
To explore whether distinct trajectories of anxiety and depression exist among liver transplant candidates, and to gain insight into demographic, clinical, and individual characteristics related with these trajectories.
A multicentre, prospective cohort study among 216 liver transplant candidates. Respondents filled out a questionnaire at study entrance and subsequently every 6 months until transplantation or removal from the waiting list.
Anxiety (STAI6), depression (CES-D), demographic, and individual variables were assessed by questionnaire. Clinical variables were retrieved by medical record review. The SAS PROC TRAJ procedure was used to identify distinct trajectories. Univariate and multiple ordinal logistic regression analyses were used to explore related variables.
Regarding anxiety, three stable trajectories were identified as follows: below clinical level (51%), slightly above clinical level (34%), and high above clinical level (15%). Regarding depression, four stable trajectories were identified as follows: below clinical level (23%), slightly below clinical level (34%), slightly above clinical level (28%), and high above clinical level (6%). For anxiety as well as for depression, experiencing more liver disease symptoms, a lower level of personal control, making more use of emotional coping, and making less use of task-oriented coping increased the likelihood of membership in those trajectories with higher symptom levels.
Distinct, but stable, trajectories of anxiety and depression were present in liver transplant candidates. The trajectories with symptom levels above clinical relevant levels for anxiety or depression comprised, respectively, 49% and 34% of the respondents. Therefore, psychological screening and subsequently providing appropriate interventions are warranted early in the transplant process. Statement of contribution What is already known on this subject For transplant candidates, the waiting-list period is a period of uncertainty and unpredictability. Psychological problems, such as anxiety and depression, are common among liver transplant candidates. Several demographic, clinical, and individual characteristics are associated with anxiety and depression, but these results remain inconclusive. What does this study add Distinct trajectories of symptoms of anxiety and depression are present among liver transplant candidates. Given the stability of the trajectories over time, the symptom level at baseline is indicative of the symptom level during the waiting-list period. Experiencing more liver disease symptoms, low mastery, more use of emotional coping, and less use of task-oriented coping are associated with trajectories of high symptom levels.
探讨肝移植候选者中是否存在焦虑和抑郁的不同轨迹，并深入了解与这些轨迹相关的人口统计学、临床和个体特征。
对216名肝移植候选者进行的多中心前瞻性队列研究。研究开始时，受访者填写一份问卷，随后每6个月填写一次，直至移植或从等待名单中移除。
通过问卷评估焦虑（状态特质焦虑量表6项）、抑郁（流调中心用抑郁量表）、人口统计学和个体变量。通过病历审查获取临床变量。使用SAS PROC TRAJ程序识别不同轨迹。采用单因素和多因素有序逻辑回归分析探讨相关变量。
关于焦虑，确定了三条稳定轨迹，分别为：临床水平以下（51%）、略高于临床水平（34%）和远高于临床水平（15%）。关于抑郁，确定了四条稳定轨迹，分别为：临床水平以下（23%）、略低于临床水平（34%）、略高于临床水平（28%）和远高于临床水平（6%）。对于焦虑和抑郁，经历更多肝病症状、个人控制水平较低、更多地使用情绪应对方式以及较少地使用任务导向型应对方式会增加处于症状水平较高轨迹的可能性。
肝移植候选者中存在不同但稳定的焦虑和抑郁轨迹。焦虑或抑郁症状水平高于临床相关水平的轨迹分别占受访者的49%和34%。因此，在移植过程早期进行心理筛查并随后提供适当干预是必要的。贡献声明关于该主题已知的信息对于移植候选者来说，等待名单期是一个充满不确定性和不可预测性的时期。心理问题，如焦虑和抑郁，在肝移植候选者中很常见。一些人口统计学、临床和个体特征与焦虑和抑郁有关，但这些结果仍无定论。本研究增加了什么肝移植候选者中存在焦虑和抑郁症状的不同轨迹。鉴于轨迹随时间的稳定性，基线时的症状水平可指示等待名单期的症状水平。经历更多肝病症状、低掌控感、更多地使用情绪应对方式以及较少地使用任务导向型应对方式与高症状水平轨迹相关。
