Risk Factors for Depression in Patients Undergoing Hematopoietic Cell Transplantation
Despite the prevalence and known adverse impacts of depression after hematopoietic cell transplantation (HCT), little is known about the trajectory of depression following HCT, or which pre-transplant risk factors might help predict new or worsening depression post-HCT. This secondary analysis was conducted to evaluate the relationships between pre-transplant patient-reported outcomes and demographic characteristics and post-transplant depression. 228 adult HCT patients were evaluated pre-transplant (T1) and 6 to 7 weeks post-transplant (T2), using touch-screen computers in the transplant clinic during participation in a larger trial. Measures included the Symptom Distress Scale, the EORTC QLQ-C30 for quality of life, a single-item Pain Intensity question, and the PHQ-9 for measurement of depression. At T1, rates of depression were quite low with only 6% of participants endorsing moderate or higher depression. At T2, however, 31% had moderate or higher depression. We observed a strong linear relation in PHQ-9 scores between T1 and T2 (p<.0001). T1 depression score was a significant predictor of depression scores at T2 (p=.03), as was poorer emotional function at T1 (p<.01). Results indicate that depression is common post-HCT, even for patients with low depression pre-transplant. Frequent screening for depressive symptoms at critical time points, including 6-7 weeks post-HCT, are needed in this population, followed by referrals to supportive care as appropriate.
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