Psychological and Immunological Reactions of Family Members to Patients Undergoing Bone Marrow Transplantation

Department of Psychiatry, University of Colorado Cancer Center, Denver, USA.
Psychosomatic Medicine (Impact Factor: 3.47). 11/1991; 58(5):472-80. DOI: 10.1016/0163-8343(91)90078-B
Source: PubMed


The authors' goal was to evaluate the impacts of patients' bone marrow transplant (BMT) on their spouse/partner's (subjects) psychological and immunological status at four key points in the course of their transplant. Subjects' (N = 24) psychological and immunological status was prospectively evaluated at four key points in the patient's BMT which included: at patients' admission to hospital and 0-, 20-, and 34-day intervals after BMT infusion. Psychological variables examined included: a) general psychological distress and negative affect; b) tendency to respond in a socially desirable manner; c) state negative affect; and d) coping style, specifically if escape-avoidance coping was used. Immune variables examined included: percentages of total T cells and of CD4+, CD8+ cells, B cells, and natural killer (NK) cells, and NK cytotoxicity. Greatest abnormality in immune variables was detected before the initiation of BMT (i.e., between admission and day 0) with normalization between days 21 and 34 thereafter. During the waiting period before BMT, the subjects had the highest scores on negative affects, escape-avoidance coping, and psychological symptoms. These progressively declined after the BMT procedure. Significant correlations were found among trait anxiety, escape-avoidance coping, and total percentage of T cells and of CD4+ cells. Escape-avoidance coping was reliably correlated with percentage of B cells. The greatest psychological and immunological impacts on spouse/partners of BMT patients were found in the period directly after hospital admission and before BMT infusion. Alterations in immune values occurred in anticipation of BMT in the spouse/partners. Psychological symptoms followed this same pattern, being most elevated before BMT and decreasing in the successive evaluations post-BMT for the spouse/partners. The most significant and consistent psychological variable in predicting immune changes was escape-avoidance coping, with less escape-avoidance coping predicting better immune functioning.

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Available from: Ann Futterman Collier, Apr 11, 2014
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    • "The level of depression is much lower than that detected in a study done by Nelson et al. which showed 66% of mothers experienced depression pre-BMT (Nelson et al. 1997). Futterman et al. conducted a study of BMT patients and spouses to evaluate mechanisms of psychological distress and noted that patients and spouses experienced greatest negative and psychological stress during the period prior to admission for BMT (Futterman et al. 1996). The body of literature on psychosocial issues prior to BMT suggests a high level of stress in this acute time-period, but little is known about the long term effects of stress, anxiety and depression associated with illness uncertainty and anticipation of BMT over long periods of time. "
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    • "Appraisals of events as stressful, and the resulting emotional distress, contribute to a series of central nervous system and endocrine changes that can impact immunity. There are only limited immune data from spouses of cancer patients, but the available studies suggest compromised cellular immunity (Futterman et al., 1996), poorer inflammatory control (2009), and, in the only study examining immunocompetence among spouses of cancer patients with recurrence, suppressed response to skin test antigens (Mortimer et al., 2005). "
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    • "This may induce regression, withdrawal, depression, and physical discomfort) such as abdominal pain and vomiting as well as the expression of violent anger and extreme dependence, leading to resistance or rejection of treatments such as oral medication and necessary procedures, and the medical staff may have difficulty in coping with these reactions (Kellerman et al., 1979; Günter et al., 1999) Moreover, sufficient mental care of not only the patient but also the family is indispensable for successful transplantation (Futterman et al., 1996), and active involvement of a psychiatrist is important (Kiss et al., 1994). "
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