From the Departments of Nursing Research (Annema, Roodbol) Health Psychology, (Ranchor), Gastroenterology and Hepatology (Drent), Public Health (Stewart), and Surgery (Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation) (Porte), University Medical Center Groningen, University of Groningen; Department of Gastroenterology and Hepatology (Metselaar), Erasmus Medical Center, Rotterdam; and Department of Gastroenterology and Hepatology (Hoek), Leiden University Medical Center, the Netherlands.
Psychosom Med. 2018 Feb/Mar;80(2):174-183. doi: 10.1097/PSY.0000000000000539.
The aims of the study were to examine whether distinct trajectories of anxious and depressive symptoms are present among liver transplant recipients from before transplantation to 2 years afterward, to identify associated demographic, clinical, and individual characteristics, and to examine the influence of distinct trajectories on outcomes.
A prospective, multicenter cohort study was performed among 153 liver transplant recipients. Data were retrieved using questionnaires administered before transplantation and at 3, 6, 12, and 24 months after transplantation. Clinical data were retrieved by medical record review. Latent class growth analysis was used to identify distinct trajectories. χ test, analyses of variance, and multinomial logistic regression were used to identify associated variables and the impact of the distinct trajectories on outcomes.
Three distinct trajectories for symptoms of anxiety (State-Trait Anxiety Inventory-short form) as well as depression (Center for Epidemiological Studies Depression Scale) were identified: "no symptoms," "resolved symptoms," and "persistent symptoms." The trajectories of persistent anxiety and depression comprised, respectively, 23% and 29% of the transplant recipients. Several clinical and individual variables were associated with the trajectories of persistent anxiety and/or depression: experiencing more adverse effects of the immunosuppressive medication, lower level of personal control, more use of emotion-focused coping, less disclosure about the transplant, and more stressful life events. The trajectories of persistent symptoms were associated with worse outcomes regarding medication adherence and health-related quality of life, but not with mortality.
A significant subset of transplant recipients showed persistent symptoms of anxiety and depression from before to 2 years after transplantation. These results emphasize the importance of psychosocial care in the transplant population.
本研究旨在探讨肝移植受者在移植前至 2 年后是否存在不同的焦虑和抑郁症状轨迹，并确定相关的人口统计学、临床和个体特征，以及研究不同轨迹对结局的影响。
采用前瞻性、多中心队列研究，对 153 例肝移植受者进行研究。在移植前和移植后 3、6、12 和 24 个月使用问卷调查收集数据。通过病历回顾获取临床数据。采用潜在类别增长分析识别不同轨迹。采用 χ 检验、方差分析和多项逻辑回归分析识别相关变量以及不同轨迹对结局的影响。
确定了焦虑（状态-特质焦虑问卷短表）和抑郁（流行病学研究中心抑郁量表）症状的三种不同轨迹：“无症状”、“症状缓解”和“症状持续”。持续焦虑和抑郁的轨迹分别占移植受者的 23%和 29%。一些临床和个体变量与持续焦虑和/或抑郁的轨迹相关：经历更多免疫抑制药物的不良反应、个人控制水平较低、更多地使用情绪聚焦应对、对移植的隐瞒较少、以及更多的生活压力事件。持续症状轨迹与药物依从性和健康相关生活质量较差相关，但与死亡率无关。
相当一部分移植受者在移植前至 2 年后持续存在焦虑和抑郁症状。这些结果强调了在移植人群中进行心理社会护理的重要性。
