Jean M. Goycoolea

Posttraumatic stress disorder and service utilization among urban mental health center clients.

Although the urban poor are at high risk for exposure to trauma, community mental health clinics rarefy diagnose clients with PTSD. Failure to diagnose PTSD may undermine the effectiveness of services provided. Our objectives were to (1) assess prevalence of traumatic experiences and PTSD, and (2) examine differences in service utilization between those who had PTSD and those who did not. Interview data were gathered from 181 urban psychiatric outpatients. A substantial number of clients had experienced at least one lifetime trauma (94%), and of those, 42% had PTSD during the past year. Analyses comparing service use between PTSD and nonPTSD clients supported our expectation that clients with PTSD would use more mental health services, and would be less satisfied with services than their nonPTSD counterparts.

Factors associated with attrition from a national bone marrow registry

During its 10-year existence, the National Marrow Donor Program (NMDP) has been extremely successful at recruiting potential bone marrow donors to join the volunteer registry. Due in part to successful recruitment and the longevity of the registry, the focus of the NMDP has now shifted to decreasing potential attrition when volunteers are recontacted for additional testing to determine whether they would be the optimal donor for a specific patient. Our own interest in the bone marrow donation process led us to examine four domains of variables – demographic characteristics, volunteer history, recruitment-related characteristics and donation-related concerns – that we hypothesized would be associated with increased likelihood of donor attrition at a key donor decision-point (DR-stage blood typing). Questionnaires were mailed to potential donors after they were contacted at the DR-stage, and had made the decision of whether or not to continue with blood typing. Our final sample included 756 volunteers who decided to continue with typing, and 258 individuals who declined further participation in the registry. In the bivariate analyses, factors in three of the four domains (all except demographic characteristics) were found to be substantially correlated with likelihood of attrition. Logistic regression indicated that nine central variables across the three domains produced the majority of increased attrition likelihood. Finally, a dose-response analysis suggested that as the number of attrition-related factors endorsed by an individual increased, his/her likelihood of dropping out of the registry also increased. Implications for future research and interventions to reduce potential donor attrition are discussed.

The effects of bereavement on adult sibling bone marrow donors’ psychological well-being and reactions to donation

As living organ, tissue, and bone marrow donation become increasingly prevalent treatments for a variety of diseases, better understanding of living donors’ experiences, especially when the recipient does not survive after the transplant, also becomes more critical. Although some psychological outcome data exist concerning living donation, there have been no systematic prospective investigations, to date, of the psychological impact of bereavement among sibling bone marrow donors. Studies of bereavement effects in other donation settings such as unrelated bone marrow donation and related kidney donation, suggest that bereavement may have a significant impact on donors’ reactions. The present investigation studied a panel of sibling bone marrow donors at three key points in the donation process in order to (1) examine donor psychological well-being across time, and (2) investigate the effect of the sibling recipient’s death on donor well-being. We surveyed sibling donors by mail 1–2 weeks prior to donation, 1–2 weeks following donation, and again 1 year after their donation. In general, all donors reported high levels of predonation self-esteem, mastery, happiness and life satisfaction. As might be expected, bereaved donors felt less as if their donation had really helped their sibling as time passed. However, despite such donation-specific perceptions, bereaved donors experienced global psychological gains following bereavement including enhanced self-esteem, happiness, and life satisfaction compared to donors whose siblings were still living. These findings suggest that physicians and mental health practitioners should monitor donors’ psychological well-being for extended periods post-donation, and should consider clinical interventions for bereaved and nonbereaved sibling donors.

Factors associated with ambivalence about bone marrow donation among newly recruited unrelated potential donors.

Background. Previous research has indicated that feelings of ambivalence about donation are associated with donors’ decisions not to donate and with less positive physical and psychosocial outcomes among donors who donated despite feeling ambivalent. The current study examines the prevalence of ambivalence among newly recruited potential bone marrow donors and identifies factors associated with greater ambivalence. Methods. Using a cross-sectional design, questionnaires were mailed to a stratified random sample of individuals newly recruited to the National Marrow Donor Program registry at 71 local donor centers. A total of 426 new recruits (63%) completed and returned the questionnaire. Results. Bivariate analyses indicated that multiple recruitment experience and donor perception variables were significantly associated with ambivalence. Multivariate analysis revealed that the following eight variables were uniquely associated with higher levels of ambivalence after adjusting for the effects of other key indicators: participating in other volunteer activities, joining at a drive for a specific patient, perceiving the recruitment staff as less informative, being discouraged from joining by others, not having an intrinsic commitment to donate, being encouraged by one’s culture or religion to join, believing there are risks to donation, and having a greater number of medical, work, and family concerns about donation. Conclusions. Potential donors who are motivated by an intrinsic commitment to donate, rather than extrinsic pressure, are less ambivalent about donating. In addition, recruitment staff have a potentially critical role in reducing ambivalence among new recruits by providing information that may allay any unrealistic concerns recruits may have about the medical risks and impact of donation on work and family.

An internet-based intervention to improve mental health and medical compliance in heart transplant recipients

the liver transplant performed prior to the lung transplant (PREVLITX) and 48 with a simultaneous lung and liver transplant (SIMLITX). The indications were cystic fibrosis (CF) in 23 patients, -1-antitrypsin deficiency ( -1) in 4 cases, primary pulmonary hypertension (PPH) in 5 patients, and various other diagnoses (N 6). Diagnosis was not reported in 16 cases. In 22 patients a heart/lung-liver transplant was performed. Out of the 54 procedures registered a single lung Tx was performed in 22 cases and a bilateral in 32 cases. Survival was computed using the Kaplan-Meier method for transplants performed prior to June 30, 2000: this reduced cohort included 6 transplants in the PREVLITX group and 43 in the SIMLITX group. The overall survival for both groups was 80%, 71%, 64%, 56%, and 56%, respectively, at 1, 3, 12, 36 and 60 months. The survival of the SIMLITX group was 77%, 67%, 59%, 51%, 51% at same time points. Survival for the patients who received a lung Tx after previous liver Tx was 100% at 1 year. Insufficient follow-up was available to compute survival at later time points in this group. The diagnosis groups in this cohort were too small to compare. Albeit the number of all LuLiTx procedures that have been performed worldwide is small, in selected patients this treatment modality seems to lead to survival that is comparable to what is currently achieved following lung transplantation. This strongly suggests that the lung rather than the liver is the organ that limits the long-term survival following combined LuLiTx and it is to be expected that improvements in lung transplantation will also positively impact on the outcome following LuLiTx.