title: Quality of life and mood predict posttraumatic stress disorder after hematopoietic stem cell transplantation.
abstract: BACKGROUND
  During hospitalization for hematopoietic stem cell transplantation (HCT), patients experience a steep deterioration in quality of life (QOL) and mood. To our knowledge, the impact of this deterioration on patients' QOL and posttraumatic stress disorder (PTSD) symptoms after HCT is unknown.
  
  
  METHODS
  We conducted a prospective longitudinal study of patients hospitalized for HCT. They assessed QOL using the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation (FACT-BMT) and depression and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) at the time of admission for HCT, during hospitalization, and 6 months after HCT. We also used the Hospital Anxiety and Depression Scale (HADS) to measure patients' anxiety and depression symptoms at baseline and during HCT hospitalization. The PTSD Checklist was used to assess for PTSD symptoms. Multivariable linear regression models were used to identify predictors of QOL and PTSD symptoms at 6 months.
  
  
  RESULTS
  We enrolled 90 of 93 consecutively eligible patients (97%) undergoing autologous and allogeneic HCT. Data at 6 months were available for 67 participants. At 6 months, 28.4% of participants met the criteria for PTSD and 43.3% had clinically significant depression. On multivariable regression analyses adjusting for significant covariates, changes in QOL and depression scores from week 2 of HCT hospitalization to baseline predicted worse QOL (changes in scores between week 2 and baseline [Δ] QOL: β, 0.94 [P<.0001] and Δ PHQ-9: β, -2.59 [P = 0.001]) and PTSD symptoms (Δ QOL: β, -0.40 [P<.0001] and Δ PHQ-9: β, 1.26 [P<.0001]) at 6 months after HCT.
  
  
  CONCLUSIONS
  Six months after HCT, a significant percentage of patients met the criteria for PTSD and depression. A decline in QOL and an increase in depressive symptoms during hospitalization for HCT were found to be the most important predictors of 6-month QOL impairment and PTSD symptoms. Therefore, managing symptoms of depression and QOL deterioration during HCT hospitalization may be critical to improving QOL at 6 months and reducing the risk of PTSD. Cancer 2016;122:806-812. © 2015 American Cancer Society.
authors.affiliation: Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Areej R
authors.initials: AR
authors.lastname: El-Jawahri
authors.affiliation: Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Harry B
authors.initials: HB
authors.lastname: Vandusen
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Lara N
authors.initials: LN
authors.lastname: Traeger
authors.affiliation: Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joel N
authors.initials: JN
authors.lastname: Fishbein
authors.affiliation: Department of Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Tanya
authors.initials: T
authors.lastname: Keenan
authors.affiliation: Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Gallagher
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
authors.affiliation: Palliative Care Department, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Jackson
authors.affiliation: Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Spitzer
authors.affiliation: Bone Marrow Transplant Program, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Yi-Bin A
authors.initials: YB
authors.lastname: Chen
authors.affiliation: Department of Hematology-Oncology, Massachusetts General Hospital, Boston, Massachusetts.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
mesh_terms: D000328:Adult; D000339:Affect; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D019337:Hematologic Neoplasms / Q000523:psychology* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000523:psychology*; D006760:Hospitalization; D006801:Humans; D007938:Leukemia / Q000523:psychology / Q000628:therapy; D008137:Longitudinal Studies; D008223:Lymphoma / Q000523:psychology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000523:psychology / Q000628:therapy; D009190:Myelodysplastic Syndromes / Q000523:psychology / Q000628:therapy; D055728:Primary Myelofibrosis / Q000523:psychology / Q000628:therapy; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology*; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
keywords: depression; mood; posttraumatic stress disorder (PTSD); quality of life (QOL); stem cell transplant