Department of Respiratory Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Pulmonology, University Hospital Antwerp and University of Antwerp, Edegem, Belgium.
J Clin Nurs. 2022 Mar;31(5-6):716-725. doi: 10.1111/jocn.15931. Epub 2021 Jul 2.
To explore the prevalence of psychological distress such as anxiety, depression and post-traumatic stress disorder and its associations with medication adherence in lung transplant patients.
Psychological distress after lung transplantation may impact clinical outcomes by associated behaviours such as non-adherence to medication. Evidence about the relation between psychological distress and medication adherence in lung transplant patients is limited and not well explained.
We conducted a single-centre study with a cross-sectional design in 73 lung transplant candidates and 116 recipients. Questionnaires were the Brief Symptom Inventory, Impact of Event Scale and Basel Assessment of Adherence to Immunosuppressive Medications Scale. The STROBE checklist was monitored.
In candidates, 39.7% reported (sub)clinical symptoms of depression, in recipients this was 21.6%. We observed suicidal ideation in recipients (8.6%), and candidates (5.5%). The prevalence of (sub)clinical symptoms of anxiety was 38.3% in candidates and 33.7% in recipients. After lung transplantation, 12% of the recipients reported clinical symptoms of PTSD related to the transplantation. Symptoms of anxiety and medication adherence were significantly and positively related in transplant recipients. We found no association between depressive or post-traumatic stress symptoms, and medication adherence.
In lung transplant patients, we found a high prevalence of symptoms of depression and anxiety. Recipients had high levels of post-traumatic stress symptoms related to the transplantation. The prevalence of suicidal ideation was unexpectedly high in recipients. After lung transplantation, higher levels of anxiety were related to better medication adherence. We propose that LTX recipients are very anxious to develop dyspnoea and therefore take their medication more conscientiously.
The clinical nurse specialist can play a key role in identifying and addressing psychological and behavioural problems. More prospective research on the role of anxiety and dyspnoea in lung transplant recipients is recommended.
探讨焦虑、抑郁和创伤后应激障碍等心理困扰的流行情况及其与肺移植患者药物依从性的关系。
肺移植后心理困扰可能会通过不遵守药物治疗等相关行为影响临床结果。关于肺移植患者心理困扰与药物依从性之间关系的证据有限，且解释不足。
我们进行了一项单中心、横断面研究，纳入了 73 名肺移植候选者和 116 名受者。调查问卷包括简明症状量表、事件影响量表和巴塞尔免疫抑制剂药物依从性评估量表。我们监测了 STROBE 清单。
在候选者中，39.7%报告存在（亚）临床抑郁症状，在受者中这一比例为 21.6%。我们观察到受者（8.6%）和候选者（5.5%）存在自杀意念。候选者中（亚）临床焦虑症状的患病率为 38.3%，受者中为 33.7%。肺移植后，12%的受者报告与移植相关的 PTSD （创伤后应激障碍）临床症状。受者的焦虑症状与药物依从性呈显著正相关。我们未发现抑郁或创伤后应激症状与药物依从性之间存在关联。
在肺移植患者中，我们发现抑郁和焦虑症状的患病率较高。受者对移植相关创伤后应激症状的发生率较高。受者中自杀意念的发生率出乎意料地高。肺移植后，较高的焦虑水平与更好的药物依从性相关。我们提出，肺移植受者非常担心出现呼吸困难，因此更认真地服用药物。
临床护理专家可以在识别和处理心理和行为问题方面发挥关键作用。建议对焦虑和呼吸困难在肺移植受者中的作用进行更多的前瞻性研究。
