title: Psychological distress and adherence to the medical regimen among adolescent renal transplant recipients.
abstract: This longitudinal pilot study of adolescent renal transplant recipients (a) describes the prevalence of psychological distress, (b) describes the prevalence of nonadherence, and (c) explores the association between the recipient's psychological distress and his/her subsequent medical adherence. Twenty-two adolescents, aged 13-18 years, completed two interviews that were separated by approximately 12 months. Psychological distress was assessed in three domains: symptoms of depression, anxiety, and anger. Adherence was assessed in three domains: medication taking, blood work, and clinic attendance. At the initial interview, 36.4% had symptoms of depression, 36.4% endorsed anxiety, and 18.2% endorsed excessive state anger. Non-adherence rates were 13.6% for medication, 22.7% for blood work, and 50% for missed clinic. At the second interview, nonadherence with medication remained the same and the other domains decreased. Our small pilot sample, however, limited our ability to detect statistically significant changes over time. Predictive analyses demonstrated that adolescents with excessive anger were at greater risk for subsequently missing medications than adolescents without excessive anger. These findings suggest that while symptoms of depression and anxiety are observed among some adolescents with renal transplants, only anger is associated with elevated risk for nonadherence with medication.
authors.affiliation: Department of Family Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. lilip+@pitt.edu
authors.forename: Lili
authors.initials: L
authors.lastname: Penkower
authors.forename: Mary Amanda
authors.initials: MA
authors.lastname: Dew
authors.forename: Demetrius
authors.initials: D
authors.lastname: Ellis
authors.forename: Susan M
authors.initials: SM
authors.lastname: Sereika
authors.forename: Julius M M
authors.initials: JM
authors.lastname: Kitutu
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000209:etiology; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000628:therapy; D016030:Kidney Transplantation / Q000379:methods* / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D010865:Pilot Projects; D011183:Postoperative Complications; D013315:Stress, Psychological