title: Psychosocial Predictors of Mortality Following Lung Transplantation.
abstract: Lung transplantation has become an increasingly common treatment for patients with end-stage lung disease. Few studies have examined psychosocial risk factors for mortality in transplant recipients, despite evidence suggesting that elevated levels of negative affect are associated with greater mortality following major cardiac surgery. We therefore examined the relationship between negative affect early after lung transplantation and long-term survival in a sample of 132 lung transplant recipients (28 cystic fibrosis, 64 chronic obstructive pulmonary disease, 26 idiopathic pulmonary fibrosis, 14 other) followed for up to 13.5 years (median 7.4 years) following transplantation. Patients underwent both medical and psychosocial assessments 6 months following transplantation, which included the Beck Depression Inventory-II (BDI-II), Spielberger Anxiety Inventory, and General Health Questionnaire (GHQ). Over the course of follow-up, 80 (61%) participants died. Controlling for demographic factors, native lung disease, disease severity, family income, education level, social support, and frequency of posttransplant rejection, elevated symptoms of depression (BDI-II: HR = 1.31, p = 0.011) and distress (GHQ: HR = 1.28, p = 0.003) were associated with increased mortality. Higher levels of depression and general distress, but not anxiety, measured 6 months following lung transplantation are associated with increased mortality, independent of background characteristics and medical predictors.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
authors.forename: P J
authors.initials: PJ
authors.lastname: Smith
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
authors.forename: J A
authors.initials: JA
authors.lastname: Blumenthal
authors.affiliation: Washington University School of Medicine, St. Louis, MO.
authors.forename: E P
authors.initials: EP
authors.lastname: Trulock
authors.affiliation: Washington University School of Medicine, St. Louis, MO.
authors.forename: K E
authors.initials: KE
authors.lastname: Freedland
authors.affiliation: Washington University School of Medicine, St. Louis, MO.
authors.forename: R M
authors.initials: RM
authors.lastname: Carney
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC.
authors.forename: R D
authors.initials: RD
authors.lastname: Davis
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC.
authors.forename: B M
authors.initials: BM
authors.lastname: Hoffman
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, NC.
authors.forename: S M
authors.initials: SM
authors.lastname: Palmer
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016040:Lung Transplantation / Q000009:adverse effects / Q000401:mortality / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012307:Risk Factors; D066027:Transplant Recipients / Q000523:psychology*