Holscher Courtenay M, Leanza Joseph, Thomas Alvin G, Waldram Madeleine M, Haugen Christine E, Jackson Kyle R, Bae Sunjae, Massie Allan B, Segev Dorry L
Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA.
Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA.
BMC Nephrol. 2018 Sep 4;19(1):218. doi: 10.1186/s12882-018-1024-0.
Previous studies have reported a wide range of prevalence of post-donation anxiety, depression, and regret in living kidney donors (LKDs). It is also unclear what risk factors are associated with these outcomes.
We screened 825 LKDs for anxiety and depression using 2-item GAD-2 and PHQ-2 scales and asked about regret.
Overall, 5.5% screened positive for anxiety, 4.2% for depression, and 2.1% reported regretting their donation. While there was moderate correlation between positive anxiety and depression screens (r = 0.52), there was no correlation between regret and positive screens (r < 0.1 for both). A positive anxiety screen was more likely in LKDs with a positive depression screen (adjusted relative risk [aRR] 13.72, 95% confidence interval [CI] 6.78-27.74, p < 0.001). Similarly, a positive depression screen was more likely in LKDs with a positive anxiety screen (aRR 19.50, 95% CI 6.94-54.81, p < 0.001), as well as in those whose recipients experienced graft loss (aRR 5.38, 95% CI 1.29-22.32, p = 0.02). Regret was more likely in LKDs with a positive anxiety screen (aRR 5.68, 95% CI 1.20-26.90, p = 0.03). This was a single center cross-sectional study which may limit generalizability and examination of causal effects. Also, due to the low prevalence of adverse psychosocial outcomes, we may lack power to detect some associations between donor characteristics and anxiety, depression, or regret.
Although there is a low prevalence of anxiety, depression, and regret of donation among LKDs, these are interrelated conditions and a positive screen for one condition should prompt evaluation for other conditions.
既往研究报道了活体肾供者(LKDs)捐赠后焦虑、抑郁和后悔情绪的广泛流行率。目前尚不清楚哪些风险因素与这些结果相关。
我们使用2项广泛性焦虑障碍量表(GAD-2)和患者健康问卷-2量表(PHQ-2)对825名LKDs进行焦虑和抑郁筛查,并询问其是否后悔捐赠。
总体而言,5.5%的人焦虑筛查呈阳性,4.2%的人抑郁筛查呈阳性,2.1%的人表示后悔捐赠。虽然焦虑和抑郁筛查阳性之间存在中度相关性(r = 0.52),但后悔与筛查阳性之间无相关性(两者r均<0.1)。抑郁筛查呈阳性的LKDs更有可能焦虑筛查呈阳性(校正相对风险[aRR] 13.72,95%置信区间[CI] 6.78 - 27.74,p < 0.001)。同样,焦虑筛查呈阳性的LKDs抑郁筛查更有可能呈阳性(aRR 19.50,95% CI 6.94 - 54.81,p < 0.001),接受者出现移植肾失功的LKDs也是如此(aRR 5.38,95% CI 1.29 - 22.32,p = 0.02)。焦虑筛查呈阳性的LKDs更有可能后悔(aRR 5.68,95% CI 1.20 - 26.90,p = 0.03)。这是一项单中心横断面研究,可能会限制研究结果的普遍性以及因果效应的检验。此外,由于不良心理社会结局的流行率较低,我们可能缺乏检测供者特征与焦虑、抑郁或后悔之间某些关联的能力。
尽管LKDs中焦虑、抑郁和捐赠后悔情绪的流行率较低,但这些情况相互关联,一种情况筛查呈阳性应促使对其他情况进行评估。