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


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.

Download full-text


Available from: Debra Seacord, Oct 09, 2014
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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.
    Full-text · Article · Sep 2013 · Journal of Pediatric Psychology
  • Source
    • "Depressive and anxiety disorders are the most investigated and frequent psychiatric diagnoses in HT recipients. The prevalence of posttraumatic stress disorder (PTSD) associated with transplantation has been estimated at 11% to 17% [13] [14] [15], whereas major depression seems to be more frequent (15% in the first year, 30% in the first 3 years [1] [2]). Both PTSD and major depression have been found to be associated with poor outcome in HT recipients [1] [2] [3] [4]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is growing evidence of the importance of psychiatric risk factors for predicting the outcome of heart transplantation (HT) recipients. The aim of our study was to investigate the role of major depression and posttraumatic stress disorder (PTSD) in the prediction of the outcome of HT in a consecutive sample of 107 recipients. All subjects of the study underwent a structured diagnostic interview for assessing the presence of pretransplant and posttransplant major depression and transplantation-related PTSD 1 to 5 years after HT. The adherence to medical treatment was assessed some months after the structured interview. The medical outcome (acute rejections, cancer, mortality) was followed up for 8 years on average after the interview, using a prospective design. Estimated frequency of psychiatric diagnoses after HT was 12% for transplantation-related PTSD and 41% for major depression. The presence of an episode of major depression prior to HT is a significant independent risk factor for posttransplant malignancies. Age, posttransplant malignancies and poor adherence are significant predictors of mortality in the survival analyses. The present study highlights the importance of the assessment of psychosocial variables and psychiatric diagnoses before and after transplantation in HT recipients. Our findings have important clinical implications and require replication with larger samples.
    Full-text · Article · Jan 2011 · General hospital psychiatry
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Children and adolescents who are exposed to traumatic events are helped by numerous child-serving agencies, including health, mental health, education, child welfare, first responder, and criminal justice systems to assist them in their recovery. Service providers need to incorporate a trauma-informed perspective in their practices to enhance the quality of care for these children. This includes making sure that children and adolescents are screened for trauma exposure; that service providers use evidence-informed practices; that resources on trauma are available to providers, survivors, and their families; and that there is a continuity of care across service systems. This article reviews how traumatic stress impacts children and adolescents' daily functioning and how various service systems approach trauma services differently. It also provides recommendations for how to make each of these service systems more trauma informed and an appendix detailing resources in the National Child Traumatic Stress Network that have been produced to meet this objective. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Full-text · Article · Jul 2008 · Professional Psychology Research and Practice
Show more