Parents and clinicians underestimate distress and depression in children who had a transplant.

The present study examined whether there are differences in reporting of depressive and post-traumatic stress symptoms between children who had a transplant and children who had other medical illnesses. We evaluated both the child's report about her/his symptoms and the parent or the clinician's report about these symptoms in the child. Scores on measures of depression (clinician rated vs. child rated) and post-traumatic stress (parent rated vs. child rated) were compared between medically ill children who have vs. have not had a solid organ transplant. The findings of a psychiatric evaluation are also reported. Children who have vs. have not received a solid organ transplant reported the same levels of depression and post-traumatic stress, while adults (their parents or clinicians who evaluated them) reported lower levels of depression and post-traumatic stress in the transplant group. The psychiatric evaluation revealed no differences between the groups. Children view their post-transplant course differently from adults caring for these children. Adults tend to underestimate the child's post-transplant emotional symptoms, possibly because they focus on the improved prognosis (whereas the children focus on the concrete experience of illness). The child's report of his or her emotional symptoms should be directly sought post-transplant.