Posttraumatic Stress Disorder,Quality of Life,and the Subjective Experience in Liver Transplant Recipients

Abstract

Objective:

A high prevalence of posttraumatic stress disorder (PTSD) symptoms among transplant recipients has been associated with a low adherence to treatment and poor survival. It is crucial to detect and prevent the development of posttraumatic stress in transplant settings.

Methods:

We examined the prevalence of posttraumatic stress symptoms in 3 liver transplant recipients by means of the Essen Trauma Inventory (ETI), a self-report questionnaire. The Short Form-36 was used to assess the perceived health-related quality of life. Patients were asked to indicate the most traumatic events within the context of the liver transplantation procedure.

Results:

Five patients (4.9%) fulfilled the criteria for PTSD related to liver disease or transplantation (ETI score greater than 27). In these patients, diagnosis was confirmed by a structured clinical interview. Fourteen (13.6%) patients had a partial PTSD with the ETI score less than 27 and greater than 16. Posttraumatic stress symptoms were significantly associated with perceived poor physical and mental health-related quality of life. Patients reported that the physicians’ disclosure of diagnosis was experienced as traumatic, followed by treatment in an intensive care unit and the liver transplantation itself.

Conclusions:

The ETI resulted in prevalence rates for PTSD comparable to previous studies in liver transplantation settings. Medical professionals requested additional training in how to deliver severe diagnoses to patients.

Keywords

anxiety depression liver transplantation posttraumatic stress disorder quality of life

Get full access to this article

View all access options for this article.

References

Cavalcanti-Ribeiro

Andrade-Nascimento

Morais-de-Jesus

. Post-traumatic stress disorder as a comorbidity: impact on disease outcomes. Expert Rev Neurother. 2012;12(8):1023–1037.

Edmondson

Richardson

Falzon

Davidson

Mills

Neria

. Posttraumatic stress disorder prevalence and risk of recurrence in acute coronary syndrome patients: a meta-analytic review. PLoS One. 2012;7(6): e38915. doi:10.1371/journal.pone.0038915.

Warlan

Howland

Connelly

. Detection of posttraumatic stress symptoms in patients after discharge from intensive care. Am J Crit Care. 2016;25(6):509–515.

Esser

Kuba

Scherwath

. Posttraumatic stress disorder symptomatology in the course of allogeneic HSCT: a prospective study. J Cancer Surviv. 2017;11(2):203–210. doi:10.1007/s11764-016-0579-7.

Baranyi

Krauseneck

Rothenhäusler

. Posttraumatic stress symptoms after solid-organ transplantation: preoperative risk factors and the impact on health-related quality of life and life satisfaction. Health Qual Life Outcomes. 2013;11:111. doi:10.1186/1477-7525-11-111.

Davydow

Lease

Reyes

. Posttraumatic stress disorder in organ transplant recipients: a systematic review. Gen Hosp Psychiatry. 2015;37(5):387–398. doi:10.1016/j.genhoppsych.2015.05.005.

Schelling

Richter

Roozendaal

. Exposure to high stress in the intensive care unit may have negative effects on health-related quality-of-life outcomes after cardiac surgery. Crit Care Med. 2003;31(7):1971–1980.

Dew

Myaskovsky

DiMartini

Switzer

Schulberg

Kormos

. Onset, timing and risk for depression and anxiety in family caregivers to heart transplant recipients. Psychol Med. 2004;34(6):1065–1082.

Dew

Kormos

Roth

Murali

DiMartini

Griffith

. Early post-transplant medical compliance and mental health predict physical morbidity and mortality one to three years after heart transplantation. J Heart Lung Transplant. 1999:18(6):549–562.

10.

Gries

Dew

Curtis

. Nature and correlates of post-traumatic stress symptomatology in lung transplant recipients. J Heart Lung Transplant. 2013;32(5):525–532. doi:10.1016/j.healun.2013.01.1046.

11.

Rothenhäusler

Ehrentraut

Kapfhammer

. Psychiatric and psychosocial outcome of orthotopic liver transplantation. Psychother Psychosom. 2002;71(5):285–297.

12.

Telles-Correia

Barbosa

Mega

Mateus

Monteiro

. When does quality of life improve after liver transplantation? A longitudinal prospective study. Transplant Proc. 2009;41(3):904–905. doi:10.1016/j.transproceed.2009.01.051.

13.

Annema

Roodbol

Stewart

Porte

Ranchor

. Prevalence of psychological problems and associated transplant-related variables at different time periods after liver transplantation. Liver Transpl. 2015;21(4):524–538. doi:10.1002/lt.24075.

14.

Tagay

Senf

. Essener Trauma-Inventar (ETI). Manual. Hogrefe, Göttingen; 2014.

15.

Bullinger

Kirchberger

. The SF-36 Questionnaire. Göttingen, Germany: Hogrefe; 1998.

16.

Foa

. The Post Traumatic Diagnostic Scale Manual. Minneapolis: NCS; 1995.

17.

Weiss

Marmar

. The impact of event scale—revised. In: Wilson

Keane

, eds. Assessing Psychological Trauma and PTSD. New York, NY: Guilford; 1996:399–411.

18.

Tagay

Zararsiz

Erim

. Traumatic events and posttraumatic stress disorder in Turkish-speaking patients in primary care. Psychother Psychosom Med Psychol. 2008;58(3-4):155–161. doi:10.1055/s-2008-1067357.

19.

Zanarini

Frankenburg

. Attainment and maintenance of reliability of axis I and II disorders over the course of a longitudinal study. Compr Psychiatry. 2001;42(5):369–374.

20.

Jin

Yan

Xiang

. Posttraumatic stress disorder after liver transplantation. Hepatobiliary Pancreat Dis Int. 2012;11(1):28–33.

21.

Mintzer

Stuber

Seacord

Castaneda

Mesrkhani

Glover

. Traumatic stress symptoms in adolescent organ transplant recipients. Pediatrics. 2005;115(6):1640–1644.

22.

Perkonigg

Kessler

Storz

Wittchen

. Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand. 2000;101(1):46–59.

23.

Tagay

Herpertz

Langkafel

Senf

Posttraumatic stress disorder in a psychosomatic outpatient clinic. Gender effects, psychosocial functioning, sense of coherence, and service utilization. J Psychosom Res. 2005;58(5):439–446.

24.

Simmons

Granvold

. A cognitive model to explain gender differences in rate of PTSD diagnosis. Brief Treatment Crisis Intervention. 2005;5(3):290–299.

25.

Bunzel

Titscher

Grundböck

Wollenek

. “You need a new heart”. The problem of diagnostic disclosure from the viewpoint of the affected cardiologic patient. Psychother Psychosom Med Psychol. 1991;41(11):419–428.

26.

Lerman

Daly

Walsh

. Communication between patients with breast cancer and health care providers. Determinants and implications. Cancer. 1993;72(9):2612–2620.

27.

Supelana

Annunziato

Kaplan

Helcer

Stuber

Shemesh

. PTSD in solid organ transplant recipients: current understanding and future implications. Pediatr Transplant. 2016;20(1):23–33. doi:10.1111/petr.12628.

28.

Schnurr

Hayes

Lunney

. Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for posttraumatic stress disorder. J Consult Clin Psycol. 2006;74(4):707–713.