Prevalence of psychological distress and the correlation with medication non-adherence among lung transplant patients

M.J.C. Wessels-Bakker, E.A. van de Graaf, J.M. Kwakkel-van Erp, H.G. Heijerman, W. Cahn, R. Schappin

Wednesday 13 march 2019

16:30 - 16:40h at Koningin Máximazaal

Categories: Best abstracts, Parallelsessie

Parallel session: Parallelsessie VI – Best abstracts I

Background: Psychological distress after lung transplantation (LTx) is a potential risk factor for morbidity and mortality. Knowledge about the association between depression, anxiety, post-traumatic stress, and medication non-adherence (MNA) in LTx patients is heterogeneous and limited. Therefore the aim of our study is to investigate the prevalence of anxiety, depression, and PTSD and their correlation with MNA before and after LTx.

Methods: We performed a single-center study with a cross-sectional design. Anxiety and depression were assessed with the Brief Symptom Inventory, symptoms of post-traumatic stress disorder (PTSD) with the Dutch version of the Impact of Event Scale, and medication adherence with the Basel Assessment of Adherence to Immunosuppressive Medications Scale.

Results: We assessed 35 waiting list patients (response rate 95%) and 113 patients after LTx (response rate 96%). In waiting list patients, 52% reported (sub)clinical symptoms of depression and in transplanted patients 23%. The BSI includes a question on suicidal thoughts and advises to interpret this question as a risk factor for depression. After LTx, 8 patients (7.1%) reported “few thoughts” and 2 patients (1.8%) reported “quite some thoughts” about ending their life. Prevalence of (sub)clinical symptoms of anxiety is 43% in waiting list patients and 33% in transplanted patients. After LTx, 12% reported clinical symptoms of LTx-related PTSD. Anxiety and medication adherence are significantly and positively correlated in transplanted patients (Pearson r = 0.20; p = .035). We found no relation between depression or PTSD and adherence. CF patients after LTx have an OR of 2.15 to be non-adherent to medication.

Conclusions: Symptoms of depression, anxiety, and PTSD after LTx are more prevalent compared to the Dutch general population but depression after LTx is less prevalent than in waiting list patients. Although physical wellbeing and quality of life after transplantation improves we observed a high prevalence of suicidal ideation in the transplanted patients. Higher levels of anxiety after LTx are related to better medication adherence. Anxious patients may try to avoid dyspnoea by taking medication conscientiously. CF patients after LTx are more at risk for MNA compared to patients with other native chronic lung diseases. These findings and the high disclosure of psychological distress before and after lung transplantation justifies systematic psychological screening in lung transplant care.