Article

Traumatic Stress Symptoms in Adolescent Organ Transplant Recipients

Division of Child and Adolescent Psychiatry, University of California, Los Angeles, Los Ángeles, California, United States
PEDIATRICS (Impact Factor: 5.47). 07/2005; 115(6):1640-4. DOI: 10.1542/peds.2004-0118
Source: PubMed

ABSTRACT

Symptoms of posttraumatic stress disorder (PTSD) after life-threatening medical illness have been found to predict poor outcome in preliminary studies of adults and children. However, these symptoms are rarely recognized in general medical or pediatric settings. Here we report on the first large investigation to assess prevalence and correlates of self-reported symptoms of posttraumatic stress in a nonreferred sample of adolescent liver, heart, and kidney transplant recipients.
One hundred four adolescents, ages 12 to 20 years (mean: 15.7; SD: 2.1), completed and returned the University of California, Los Angeles, PTSD Index for the Diagnostic and Statistical Manual of Mental Disorders. All participants were at least 1 year post-initial transplant and were fluent speakers of English and/or Spanish.
More than 16% of the adolescents met all symptom criteria for PTSD, and an additional 14.4% met 2 of 3 symptom-cluster criteria. Regression analysis indicated no effect of gender, ethnicity, age at interview, organ type, time since transplant, or age at transplant.
As has been found with other life-threatening pediatric conditions, solid organ transplantation can precipitate symptoms of posttraumatic stress. Symptoms are not predicted by what would be considered objective factors increasing life threat, suggesting a greater salience of subjective appraisal of threat, as has been seen in studies of childhood cancer survivors.

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    • "In addition to finding significant relationships between more barriers and less adherence in a cross-sectional sample, a subsequent 18- month longitudinal investigation showed that these barrier domains tended to be relatively stable over time and predictive of future nonadherence and negative clinical outcomes , including more hospitalizations, rejection episodes, and death (Simons, McCormick, Devine, & Blount, 2010). Pediatric transplant recipients experience increased levels of emotional difficulties, such as anxiety, depression, and posttraumatic stress symptoms (PTSS), relative to their healthy peers or peers with other chronic health conditions (e.g., Berney-Martinet et al., 2009; Fredericks, Lopez, Magee, Shieck, & Opipari-Arrigan, 2007; Mintzer et al., 2005). For example, Fredericks et al. (2007) found that based on parent proxy-report on the Child Behavior Checklist, $60% of transplant recipients scored in the clinical range for Internalizing and/or Externalizing problems, Total Problems, or at least one subscale, as compared with only 25–30% in the normative sample. "
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    ABSTRACT: This study assessed relationships among internalizing symptoms, barriers to medication adherence, and medication adherence in adolescents with solid organ transplants. The sample included 72 adolescents who had received solid organ transplants. Multiple mediator models were tested via bootstrapping methods. Bivariate correlations revealed significant relationships between barriers and internalizing symptoms of depression, anxiety, and posttraumatic stress, as well as between internalizing symptoms and medication adherence. Barriers indicative of adaptation to the medication regimen (e.g., forgetting, lack of organization) were related to medication adherence and mediated the relationship between internalizing symptoms and medication adherence. These findings indicate that barriers may serve as a more specific factor in the relationship between more general, pervasive internalizing symptoms and medication adherence. Results may help guide areas for clinical assessment, and the focus of interventions for adolescent transplant recipients who are experiencing internalizing symptoms and/or who are nonadherent to their medication regimen.
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    • "Graham-Bermann, Clark, McCarthy, & Ronis, 2005). PTSD sylnptoms in transplant recipients have been associated with medication nonadherence, perhaps because of parent or child avoidance of traumatic reminders of the transplant experience (Mintzer et 31.. 2005; Shemesh et al., 2000). The impact of traumatic stress on physical health, and the possibility that addressing children's Iraumatic stress may reduce the utilization ant1 incrcase the effectivcness of health care, provides an incentive to health care organizutions and payer systems to seek trautna-informed service ~nodels. "
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