Rachel A Annunziato1, Nicole Arrato, Melissa Rubes, Ronen Arnon. 1. Department of Psychology, Fordham University, Bronx, New York, United States; Department of Pediatrics, Kravis Children's Hospital & Recanati/Miller Transplant Institute, Icahn School of Medicine at Mount Sinai, New York, New York, United States.
Abstract
AIM: Although the transfer out of paediatrics is established as a dangerous time for transplant recipients, the reasons for this are not well understood. One possible explanation is that in general, young adulthood is a period of vulnerability to psychological distress, which could impact self-management. The purpose of the present study was to investigate whether psychological distress is associated with medication non-adherence after transfer. METHODS: Twenty paediatric liver transplant recipients (mean age = 22.42, standard deviation (SD) = 1.64) have been followed prospectively at our site for a year after they transferred from paediatrics. At their last visit in paediatrics, they completed the Symptom Checklist-90, a measure of psychological distress. Additionally, patients' medication adherence was tracked 1 year after transfer, using a validated measure, SDs of tacrolimus blood levels. RESULTS: Psychological distress and medication non-adherence after transfer were significantly correlated, r = 0.50, P = 0.04. Furthermore, there was a significant interaction between adherence status and changes in mental health after transfer. CONCLUSION: Psychological distress may be one factor behind deteriorating medical outcomes when transplant recipients transfer out of paediatric settings. It is important to consider mental health screening as a part of the transition process. Further research is needed to determine if identified patients may require services in addition to transitional interventions.
AIM: Although the transfer out of paediatrics is established as a dangerous time for transplant recipients, the reasons for this are not well understood. One possible explanation is that in general, young adulthood is a period of vulnerability to psychological distress, which could impact self-management. The purpose of the present study was to investigate whether psychological distress is associated with medication non-adherence after transfer. METHODS: Twenty paediatric liver transplant recipients (mean age = 22.42, standard deviation (SD) = 1.64) have been followed prospectively at our site for a year after they transferred from paediatrics. At their last visit in paediatrics, they completed the Symptom Checklist-90, a measure of psychological distress. Additionally, patients' medication adherence was tracked 1 year after transfer, using a validated measure, SDs of tacrolimus blood levels. RESULTS: Psychological distress and medication non-adherence after transfer were significantly correlated, r = 0.50, P = 0.04. Furthermore, there was a significant interaction between adherence status and changes in mental health after transfer. CONCLUSION: Psychological distress may be one factor behind deteriorating medical outcomes when transplant recipients transfer out of paediatric settings. It is important to consider mental health screening as a part of the transition process. Further research is needed to determine if identified patients may require services in addition to transitional interventions.
Authors: Gorden Muduma; Francis C Shupo; Sophie Dam; Natalia A Hawken; Samuel Aballéa; Isaac Odeyemi; Mondher Toumi Journal: Patient Prefer Adherence Date: 2016-01-12 Impact factor: 2.711