Agustín Martín-Rodríguez

Psychopathological Features in Transplant Patients

ALTHOUGH ORGAN TRANSPLANTATION improves life expectancy and the quality of life of the patients who receive them, psychological disorders sometimes appearing after a transplant operation must also be considered, such as changes in mood (the most frequent being depression), anxiety disorders (some transplant recipients suffer from posttraumatic stress disorder), sexual dysfunction (reduced libido, erectile dysfunction, and problems of orgasm), and changes in body image (difficulty accepting the new organ). Nevertheless, many psychosociological factors soften the psychological impact for some transplant patients. We therefore analyzed the influence of a series of psychosociological variables (expectations regarding the illness and type of family relationships after transplant) on the psychological changes in transplant patients: anxiety, depression, negative thoughts, and changes in body image.

Health-Related Quality of Life Evolution in Patients After Heart Transplantation

We analyzed the evolution of the health-related quality of life during the first year after heart transplantation (HT). A prospective, longitudinal study was performed in 13 heart transplant recipients who were assessed at four different stages: at inclusion on the HT waiting list and at 3, 6, and 12 months after receiving the graft. The instruments used were a structured interview and the 36-item Short-Form Health Survey. The results showed that, compared with pre-HT, there was progressive improvement in physical, psychologic, and social areas post-HT and that health-related quality of life was stable 6 months after receipt of the graft.

Quality of Life and Mental Health Comparisons Among Liver Transplant Recipients and Cirrhotic Patients with Different Self-Perceptions of Health

Our aim was to analyze the differences in quality of life and mental health among liver transplant recipients with better (G1) and worse (G2) perceived health and decompensated cirrhotic patients (G3). We selected two groups of patients: 168 liver transplant recipients and 75 cirrhotic patients. The Hospital Anxiety and Depression Scale and SF-36 Health Survey were used. Statistically significant differences showed that cirrhotic patients (G3) suffered the highest impairment, and liver transplant recipients with better self-perceived health (G1) had the lowest impairment, whereas patients with worse self-perceived health (G2) were in an intermediate position between both groups. Moreover, very striking differences, based on large effect sizes, were found among groups on some quality of life dimensions: physical-role, general health, vitality, and physical functioning. In conclusion, the biopsychosocial well-being of liver transplant recipients is better than that of cirrhotic patients, even if the former do not perceive their health positively.

Coping Strategies in Liver Transplant Recipients and Caregivers According to Patient Posttraumatic Growth.

The purpose of this study was to analyze the differences in coping strategies employed by liver transplant recipients and their family members according to patient posttraumatic growth. Two matched groups of 214 liver transplant recipients and 214 family members were selected. The Posttraumatic Growth Inventory and Brief COPE were used. The most relevant results were: (1) Interactive effects in active coping, support (instrumental and emotional) and acceptance strategies, which were all used more by patients with higher growth levels, while their family members showed no differences in use of these strategies by patient growth level. Furthermore, while a low level of patient growth did not mark differences between them and their caregivers, a high level did, patients employing more active coping and support (instrumental and emotional), (2) In both groups a high level of patient growth was associated with more use of positive reframing and denial than a low one, and (3) Self-blame was employed by patients more than by their caregivers. It was concluded that a high level of posttraumatic growth in liver transplant recipients is associated with more use of healthy coping strategies, basically active coping, instrumental support, and emotional support.

Comparison of Quality of Life Between Two Clinical Conditions With Immunosuppressive Therapy: Liver Transplantation and Multiple Sclerosis

OBJECTIVE We aimed to compare quality of life in two clinical conditions treated with immunosuppressants: cadaveric liver transplant recipients and multiple sclerosis patients. We also assessed the clinical significance of these results regarding a representative age-adjusted sample of the general Spanish population. METHODS Using a cross-sectional design, the SF-36 Health Survey was used to evaluate 62 patients with these chronic conditions (31 in each group) who were matched for gender. An analysis of covariance was performed to control for the influence of time from multiple sclerosis diagnosis and liver transplantation surgery until assessment. Student t test of covariate-adjusted mean values was used as the statistical test and Cohens d effect size index, to assess the magnitude of intergroup differences and assess clinical significance. RESULTS Significantly worse scores were observed among the neurological patients compared with transplant recipients regarding role-physical (P = .038), general health (P = .003), vitality (P = .034), and physical functioning (P = .049), with medium effect sizes (Cohens ds from -0.511 to -0.785). Against normative values, liver transplant recipients displayed relevant differences in all SF-36 subscales (Cohens ds from -0.569 to -0.974) except for mental health (small effect size). Likewise, multiple sclerosis patients showed much greater differences versus the general population (Cohens ds from -0.846 to -1.760). CONCLUSIONS Liver transplant recipients showed better quality of life than multiple sclerosis patients (medium effect sizes) in physical quality-of-life dimensions. Interestingly, despite having controlled for time from diagnosis/transplantation, both medical conditions showed clinically significant impairments (large and medium effect sizes) in physical and psychosocial quality-of-life domains. We concluded that transplant recipients belong to a population that still requires special health care because, even after having undergone their treatment of choice, they do not achieve normal levels of biopsychosocial functioning.

Influence of the Psychological State of Relatives on the Quality of Life of Patients at 1 Year After Transplantation

We analyzed the influence of the psychological state of relatives on the quality of life of patients at 1 year after transplantation. We selected 2 groups: 94 transplant patients (47.9% liver, 40.4% kidney, and 11.7% heart) of mean age 49.42 years (SD, 11.21 years) and their close relatives (n = 94). All participants were assessed at 1 year after transplantation, using a Psychological Survey (both groups); the Hospital Anxiety and Depression Scale and the Quality of Life Questionnaire (transplant patients); and the Leeds Scales for the Self-Assessment of Anxiety and Depression (relatives). The results revealed that transplant patients whose relatives had more symptoms of anxiety and depression at 1 year after transplantation showed a decreased quality of life.

Evolution of Quality of Life in Renal Transplant Recipients and Patients With Multiple Sclerosis: A Follow-up Study

OBJECTIVE We aimed to compare the evolution of quality of life in 2 medical conditions under immunotherapy (cadaveric renal transplantation [G1] and multiple sclerosis [G2]), and to assess the clinical significance of the results compared with a representative age-adjusted sample of the general Spanish population (G3). METHODS Using a mixed design (2 × 2), the SF-36 Health Survey was administered to 60 patients with one of these clinical conditions (30 in each group; the patient group factor), matched for gender, and homogenized regarding age and working status. All renal patients had undergone transplantation 6 months before the first assessment, and all neurological patients presented a relapsing-remitting course and a mild-moderate disability level. Both patient groups were assessed a second time 6 months later (the phase factor). A mixed analysis of covariance was computed controlling for age as a covariate. Cohens d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 5821). RESULTS Statistically significant differences were found between patient groups in vitality, bodily pain, social functioning, and mental health (P < .01), in which worse levels were displayed by patients with multiple sclerosis in both phases (Cohens ds1-2 from 0.61 to 1.40). Likewise, an interactive effect was observed in physical functioning [F(1,57) = 12.93; P = .001], such that the performance of daily physical activities improved in renal recipients after 6 months, but it decreased in neurological patients. Patients with multiple sclerosis showed higher, clinically significant impairment in all SF-36 dimensions in both phases compared with renal recipients (Cohens ds2-3 from -0.50 to -1.61), who presented clinically significant impairment in general health, role-physical, and role-emotional (Cohens ds1-3 from -0.73 to -1.28). CONCLUSIONS Renal transplant recipients need specialized health care 1 year after transplantation because they still display relevant impairment in daily functioning compared with the general population.

Post-traumatic growth and its relationship to quality of life up to 9 years after liver transplantation: a cross-sectional study in Spain

Objective Little is known concerning post-traumatic growth (PTG) after liver transplantation. Against this backdrop the current study analysed the relationship between PTG and time since transplantation on quality of life. Furthermore, it compared PTG between liver transplant recipients and their caregivers. Design Cross-sectional case–control study. Setting University Hospital in Spain. Participants 240 adult liver transplant recipients who had undergone only one transplantation, with no severe mental disease, were the participants of the study. Specific additional analyses were conducted on the subset of 216 participants for whom caregiver data were available. Moreover, results were compared with a previously recruited general population sample. Outcome measures All participants completed the Posttraumatic Growth Inventory, and recipients also filled in the 12-Item Short-Form Health Survey. Relevant sociodemographic and clinical parameters were also assessed. Results In the sample of 240 recipients, longer time since transplantation (>9 years) was associated with more pain symptoms (p=0.026). Regardless of duration, recipients showed lower scores on most quality of life dimensions than the general population. However, high PTG was associated with a significantly higher score on the vitality quality of life dimension (p=0.021). In recipients with high PTG, specific quality of life dimensions, such as bodily pain (p=0.307), vitality (p=0.890) and mental health (p=0.353), even equalled scores in the general population, whereas scores on general health surpassed them (p=0.006). Furthermore, liver transplant recipients (n=216) compared with their caregivers showed higher total PTG (p<0.001) and higher scores on the subscales relating to others (p<0.001), new possibilities (p<0.001) and appreciation of life (p<0.001). Conclusions Our findings highlight the protective role of PTG in the long-term outcome of liver transplant recipients. Future studies should analyse and develop psychosocial interventions to strengthen PTG in transplant recipients and their caregivers.

Social functioning as a predictor of the use of mental health resources in patients with severe mental disorder.

Previous studies have tried to determine the factors causing greater use of health resources by patients with mental disorders. These studies have essentially focused on socio-economic variables. Nevertheless, many other variables, such as social functioning, have not yet been explored. This study aims to assess the effect of social functioning on mental health service use in a sample of patients with severe mental disorder (schizophrenia, other psychotic disorders or bipolar affective disorder) in an area of Spain. The Social Functioning Scale (SFS) was administered to 172 family members of patients with a severe mental disorder who were receiving care at a community mental health unit. Analysis of bivariate logistic regression identified specific areas as predictors of the use of mental health resources over a 12-month follow-up period. The overall social functioning score predicted need for hospital admissions. In addition, interpersonal behaviour had a major role in the number of outpatient visits, while social isolation significantly predicted the need for hospitalization. These results point out the necessity for including psychosocial variables, such as social functioning in current mental health resource use models.

Comparison of the Affective Symptomatology Between Liver Transplant Recipients and Patients With Multiple Sclerosis Considering Their Functional Impairment

OBJECTIVES We aimed to compare the affective symptomatology in two medical conditions under immunotherapy (cadaveric liver transplantation [G1] and multiple sclerosis [G2]), considering their functional impairment, and to assess the clinical significance of the results regarding a representative age-adjusted sample of the general Spanish population (G3). METHODS Using a cross-sectional design, 164 patients (82 per clinical group) were selected, matched for gender, and homogenized regarding age and functional impairment according to the Physical functioning subscale from the SF-36 Health Survey. The criterion variables were the Mental health and Role-emotional SF-36 subscales and the Hospital Anxiety and Depression Scale. An analysis of covariance was conducted, controlling for age and the Physical functioning score as covariates. Cohens d was reported as an effect size index and to analyze the clinical significance regarding a representative age-adjusted sample of the general Spanish population (n = 7881). RESULTS No statistically significant differences were found between conditions in any affective dimension (P > .05; ds₁₋₂ from 0.08 to 0.30) or in the percentage of clinical cases regarding the anxious (P = .628) or depressive spectrum (P = .716). The neurological patients showed clinically significant impairment in both SF-36 subscales (ds₂₋₃ = 0.55 and 0.52, respectively), but transplant recipients only differed from the general population in Role-emotional (d₁₋₃ = 0.81). CONCLUSIONS Despite having controlled for functional impairment, important deterioration in daily functioning was still found in liver recipients due to emotional problems, and no relevant differences were observed even when compared with a neurodegenerative condition such as multiple sclerosis.