Nonverbal Communication and Psychopathology in Kidney Transplant Recipients

Factors Affecting Anxiety of Kidney Transplant Recipients According to Donor Type: A Descriptive Study

PURPOSE

High anxiety among kidney transplant recipients has negative psychosocial consequences for health quality. This study aims to determine the risk factors that affect levels of anxiety in recipients of kidney transplants according to living and deceased donor types.

DESIGN

The study was conducted using a descriptive correlational research method.

METHODS

The study conducted research with 330 kidney transplant recipients (from 261 live and 69 cadaver donors) who agreed to participate between February and July 2019. Participants completed the State-Trait Anxiety Inventory, which assesses state and trait anxiety.

FINDINGS

Participants had low state anxiety and moderate trait anxiety scores. A statistically significant, positive, moderate correlation was found between state anxiety scale and trait anxiety scale mean scores of recipients of kidney transplants from both living and deceased donors. According to a regression analysis of trait anxiety scores of transplant recipients from living donors, positive independent risk factors for anxiety include kidney transplant recipients with a low income, receiving kidneys from male donors, drug noncompliance, sleep disorders, and mental problems.

CONCLUSIONS

Both kidney transplant recipients from living and deceased donors had low state anxiety and moderate trait anxiety. Nurses should develop effective intervention strategies that continue throughout life to reduce the anxiety of kidney transplant recipients.

Quality of Life and Mental Health in Kidney Transplant Recipients During the COVID-19 Pandemic

Introduction: The COVID-19 pandemic has led to an increase in mental distress such as phobic anxieties, depressive reactions, hypochondriac concerns, and insomnia. Among the causes are risk of infection and prolonged isolation. This study aimed to analyze psychopathological variables and dysfunctional lifestyles related to adequate therapeutic compliance in kidney transplant recipients. Methods: Eighty-nine kidney transplant recipients were evaluated using an online protocol including a questionnaire concerning habits, lifestyle and psychophysical well-being in the COVID-19 period, the Middlesex Hospital Questionnaire (MHQ) and the SF-36 Health Survey to evaluate the perception of their physical and emotional health. Results: Of these recipients, 28.6% reported changes in their emotional state. Sleep quality deteriorated for 16.1%. Anxiety (M = 5.57, r = 0.33; p < 0.05) and phobia (M = 6.28, r = 0.26; p < 0.05) correlated with concerns related to physical health. There was no negative impact on relational and socialization aspects, which were likely well compensated by the use of remote technologies such as video phone calls, Zoom meetings and use of computers (r = 0.99; r = 0.80; p < 0.05). Conclusions: It would be interesting to maintain this remote visit and interview mode to monitor, on a clinical and psychological level, kidney transplant recipients in subsequent follow-ups (12-18 months), to check for any psychopathological disorders and/or changes in their resilience capacity in the Coronavirus emergency.

Analysis of Psychopathologic Elements as a Compliance Limitation: Team Work as a Therapeutic Response

INTRODUCTION

The psychological evaluation of the patient, carried out through psychodiagnostic tests, clinical interviews, and a joint work with the medical-surgical team, provided useful information to assess the compliance of the kidney transplant recipient.

METHODOLOGY

Two hundred and forty-five visits were carried out between September 2018 and May 2019 in the General Surgery and Organ Transplant Department of the San Salvatore Hospital, L'Aquila. The visits consisted of clinical interviews, targeted psychodiagnostic evaluations, graphic-projective tests, and personality and cognitive structure evaluation tests. These assessments were key not only to defining the patient's personality picture but also to offering suitable psychological support to patients on waiting lists for transplantation, during hospitalization, and during follow-up visits from transplantation phases.

RESULTS

From the analysis of the tests and from the clinical and support interviews, some of the patients presented forms of psycho-emotional immaturity that impaired the predisposition to compliance and ultimately the establishment of the therapeutic alliance. During 8 months, 18 compliance limit cases were observed, 5 patients were sent to mental health centers, and 13 psychological support courses were activated within the Regional Transplant Center-Abruzzo Region Molise Region. No structured psychological support courses were deemed necessary for 9 of these 13 cases, whereas 4 were sent to the mental health centers.

CONCLUSIONS

By assessing the complexity of each patient from a medical and a psychological point of view and by considering the high number of transplant surgeries currently occurring, it can be noted that compliance to therapy is strongly linked to the reliability of the relationships between patients and caregivers.

Critical Behavior and Psychopathologic Variables of the Parent-Child Couple in Living Kidney Transplantation

BACKGROUND

Living kidney donation is a complex emotional experience for donor candidates and recipients. The international literature underlines the importance of the type of donor-recipient bond to understand specific problems of donor candidates and optimize psychosocial evaluation and support for these patients.

METHODS

The aim of our study was to analyze the emotional experience of donating in the living couple according to the type of donor-recipient bond (parental/nonparental) and the possible presence of psychopathologic symptoms in the couples pretransplantation and post-transplantation.

RESULTS

Thirty donor-recipient couples (8 nonparental, emotionally linked couples [husband-wife or wife-husband], 22 genetically linked parental couples [16 parent-son or parent-daughter, 6 siblings]), recruited at the Organ Transplant Unit (University Hospital of Catania), were evaluated with a questionnaire (prepared ad hoc by the authors) to investigate the experience of donation in the couple and the aspects of the donor-recipient relationship in pre- and post-transplantation, and with the SCL-90-R to study the couples' possible psychopathologic variables before the donation and in the follow-up 24 months post-transplant.

CONCLUSIONS

The authors have seen in their study how, in particular, the parent-child bond complicates the donation process, especially when the sons are young subjects. The "mental distress" that emerged and the "unpredictability" of behaviors of these subjects makes the adaptation process more complicated with difficulty in accepting the organ received. It is certainly necessary for transplant psychiatrists and psychologists to keep them "hooked" and work with them to increase awareness and therefore clarity of their behaviors.

Study of Defense Mechanisms in Kidney Transplanted Subjects

Defenses mechanisms are defined as the tools an individual uses to manage instincts, drives, and affects. Transplantation is a stressful event that requires the body to mobilize its internal and external defenses and implement coping and adaptation strategies, which can be essential for overcoming the painful and potentially dangerous environmental, existential, and relational situations that may occur after transplantation. The aim of our study was to analyze the defense styles in 50 kidney transplanted subjects and to correlate the latter with any psychopathology and the quality of life subjectively perceived. The Defense Style Questionnaire was administered to evaluate the defense mechanisms. The Symptom Checklist-90-R (SCL-90-R) was used for the evaluation of any psychopathology. Quality of life was studied using the Complete Form Health Survey (SF-36). The "somatization" (SOM) and "anxiety" (ANX) dimensions of the SCL-90 R correlated significantly with the "reaction formation" (RF) neurotic defense (RF/SOM r = .893; RF/ANX r = .966; P < .05). A good perception of one's "general health" (GH) correlated significantly with the "humor" (HU) and "sublimation" (SU) mature defenses (HU/GH r = .681; SU/GH r = .524; P < .05). Kidney transplanted subjects are exposed to persistent physical and psychosocial stress and each transplanted subject uses their own defense mechanisms to contain the mental pain and reduce the emotional stress derived from the transplantation experience. Identifying the different kinds of defenses (mature, immature, or neurotic) can be an effective way to search for predictive indices of a good quality of life and adherence to treatments.