Postoperative Psychological Disorders Among Heart Transplant Recipients: A Meta-Analysis and Meta-Regression

A Cross-Sectional Study of Cognitive Function, Illness Perceptions, and Immunosuppression Medication Adherence After Heart Transplantation

BACKGROUND

There are few studies that examine relationships between cognitive function, illness perceptions, and medication adherence after heart transplantation, limiting the development of effective adherence-promoting interventions.

OBJECTIVE

The purpose of this study was to describe relationships between cognitive function, illness perceptions, and medication adherence among heart transplant recipients.

METHODS

A cross-sectional, observational design was used. Measures included the telephone-Montreal Cognitive Assessment (t-MoCA©), Patient Health Questionnaire-9, Brief Test of Adult Cognition by Telephone, Basel Assessment of Adherence to Immunosuppressive Medications Scale, and the Brief Illness Perceptions Questionnaire. Descriptive statistics, point-biserial correlations, Pearson's correlations, and logistic regression were used to describe relationships.

RESULTS

Of the 35 participants (mean age: 61 years [SD: 10.3], 71.4% male, 71.4% white), 31.4% (n = 11) were classified as nonadherent to their immunosuppression medications. Higher immediate word recall, indicating better episodic memory (memory for autobiographical and recent events), and higher illness coherence scores were associated with not missing doses of medication. Higher t-MoCA© total scores, indicating normal cognitive function, and lower depression scores were associated with taking medications on time. More than 22% (n = 8) of participants scored less than 19 on the t-MoCA©, an indication of mild cognitive impairment.

CONCLUSION

Cognitive impairment may be more common among heart transplant recipients than what is currently recognized, and specific domains of cognitive function were related to medication adherence after transplantation in this study. Future studies should include longitudinal evaluations of cognitive function, depression, and medication adherence. Consideration of these relationships is needed when designing adherence-promoting interventions for this population.

ACLP Best Practice Guidance: Evaluation and Treatment of Depression in Solid Organ Transplant Recipients

We present Academy of Consultation Liaison Psychiatry best practice guidance on depression in solid organ transplant (SOT) recipients, which resulted from the collaboration of Academy of Consultation Liaison Psychiatry's transplant psychiatry special interest group and Guidelines and Evidence-Based Medicine Subcommittee. Depression (which in the transplant setting may designate depressive symptoms or depressive disorders) is a frequent problem among SOT recipients. Following a structured literature review and consensus process, the Academy of Consultation Liaison Psychiatry transplant psychiatry special interest group proposes recommendations for practice: all organ transplant recipients should be screened routinely for depression. When applicable, positive screening should prompt communication with the mental health treating provider or a clinical evaluation. If the evaluation leads to a diagnosis of depressive disorder, treatment should be recommended and offered. The recommendation for psychotherapy should consider the physical and cognitive ability of the patient to maximize benefit. The first-line antidepressants of choice are escitalopram, sertraline, and mirtazapine. Treating depressive disorders prior to transplantation is recommended to prevent posttransplant depression. Future research should address the mechanism by which transplant patients develop depressive disorders, the efficacy and feasibility of treatment interventions (both pharmacological and psychotherapeutic, in person and via telemedicine), and the resources available to transplant patients for mental health care.

Posttraumatic Stress Disorder as a Consequence of Acute Cardiovascular Disease

PURPOSE OF REVIEW

To provide an update of the current evidence of cardiac disease-induced posttraumatic stress disorder (CDI-PTSD) with a focus on acute coronary events.

RECENT FINDINGS

A cardiovascular disease, particularly a life-threatening cardiac event is often a highly stressful experience that can induce PTSD in patients and their caregivers, taking a chronic course if left untreated. There are several features distinguishing CDI-PTSD from "traditional" PTSD induced by external trauma, namely enduring somatic threat, inability to avoid trauma-related cues and hyperarousal with internal body sensations leading to constant fear of recurrent cardiac events. An increased risk of recurrent CVD events may be explained by pathophysiological changes, an unhealthy lifestyle and non-adherence to cardiac treatment. A trauma-focused approach might be useful to treat CDI-PTSD. Treatment options for patients and caregivers as well as long-term effects of trauma-focused interventions on physical and mental health outcomes should be future research directions.

Prevalence of Violence against Providers in Heart and Lung Transplant Programs

Workplace violence in healthcare institutions is becoming more frequent. The objective of this study was to better understand the nature of threat and physical acts of violence from heart and lung transplant patients and families toward healthcare providers and suggest programmatic mitigation strategies. We administered a brief survey to attendees at the 2022 International Society of Heart and Lung Transplantation Conference in Boston, Massachusetts. A total of 108 participants responded. Threats of physical violence were reported by forty-five participants (42%), were more frequently reported by nurses and advanced practice providers than physicians (67% and 75% vs. 34%; p < 0.001) and were more prevalent in the United States than abroad (49% vs. 21%; p = 0.026). Acts of physical violence were reported by one out of every eight providers. Violence against providers in transplant programs warrants closer review by health systems in order to ensure the safety of team members.

Reproductive health after thoracic transplantation: An ISHLT expert consensus statement

Pregnancy after thoracic organ transplantation is feasible for select individuals but requires multidisciplinary subspecialty care. Key components for a successful pregnancy after lung or heart transplantation include preconception and contraceptive planning, thorough risk stratification, optimization of maternal comorbidities and fetal health through careful monitoring, and open communication with shared decision-making. The goal of this consensus statement is to summarize the current evidence and provide guidance surrounding preconception counseling, patient risk assessment, medical management, maternal and fetal outcomes, obstetric management, and pharmacologic considerations.

Depression in transplantation

PURPOSE OF REVIEW

To review and summarize the literature published between 1 January 2020 and 30 June 2022, on the prevalence, risk factors and impact of depression in transplant population.

RECENT FINDINGS

Depression is common in transplantation candidates and recipients, with a prevalence up to 85.8% in kidney recipients. Multiple studies have indicated after transplantation depression correlates with increased mortality and with higher healthcare utilization. Social risk factors for posttransplant depression include financial difficulties and unemployment, while less is understood about the biological substrate of depression in this population. There is evidence that dynamic psychotherapy is effective for depression in organ transplant recipients, while cognitive behavioral therapy or supportive therapy did not lead to improvement of depression in transplant recipients. For living organ donors, the rates of depression are similar to the general population, with financial factors and the clinical status of the recipient playing a significant role.

SUMMARY

Depression is a common finding in transplant population. More research is needed to understand the biological substrate and risk factors and to develop effective treatment interventions.

Prevalence of anxiety and depression among pregnant women during the COVID-19 pandemic: a meta-analysis

PURPOSE

Coronavirus disease (COVID-19) is a newly emerged respiratory illness, which has spread around the world. Pregnant women are exposed to additional pressure due to the indirect adverse effects of this pandemic on their physical and mental health. Since the psychological wellness framework is weak in developing countries, it is likely that geographical factors affect the prevalence. Therefore, the goal of this meta-analysis is to investigate the prevalence of anxiety and depression among pregnant women during the COVID-19 pandemic.

METHODS

We searched databases including PubMed/MEDLINE, Web of Science, Cochrane Library for articles. The quality of studies was determined based on the STROBE checklist. I2 and Cochrane Q-test were used to determine heterogeneity. Fixed effects and/or random effects models were also employed to estimate pooled prevalence.

RESULTS

Since heterogeneity was fairly high in all analyses, the random effect model was used. According to the results of random effects in the meta-analysis, the pooled prevalence was 18.7% (95% CI: 0.06-0.36%; I2=99%,P<0.001) for anxiety and 25.1% (95% CI: 0.18-0.33%; I2=97%, P<0.001) for depression. The results of continent subgroup analysis showed that the prevalence of anxiety was higher in western country (38%) than in Asia country (7.8%). The prevalence of anxiety in Italy (38%), Canada (56%), Pakistan (14%), Greece (53%), Sri Lanka (17.5%), and China (0.3-29%) and Iran 3.8% as well as the prevalence of depression in Canada (37%), Belgium (25%), Turkey (35.4%), Sri Lanka (19.5%), and China (11-29%) has been reported.

CONCLUSION

Covid-19 may impose extra pressure on the emotional wellbeing of pregnant women. Therefore, there is an urgent need for resources to help mitigate anxiety and depression in pregnant women.

Effect of horticultural therapy on mental health: A meta-analysis of randomized controlled trials

WHAT IS KNOWN ON THE SUBJECT?: Mental health assessment is a common topic in horticultural therapy (HT). Some study findings were contrary to positive findings, although several studies have explored the effect of HT on mental health and reported positive results. There is weak evidence in the benefits of HT based on evidence-based medicine. Stronger evidence of the link between HT and mental health will help in policy making by health policy makers and governments. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The purpose of this meta-analysis of randomized controlled trials (RCTs) was to explore the effect of HT on mental health. This study is the first meta-analysis of RCTs to provide critical evidence that HT has a positive effect on mental health. The effect size of HT on mental health was medium (0.55). The included studies had no negative effects on mental health. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: HT should be considered a useful therapy to be integrated in healthcare settings by horticultural therapists to improve mental health. In the HT program, indoor and outdoor plant activities, plant-related arts, crafts and other activities were common interventions to improve specific mental health problems through at least eight sessions. ABSTRACT: Introduction HT has been widely used to promote mental health. However, heterogeneity and sample size issues of randomized controlled trials made it challenging to illustrate effect sizes across the evidence. Aim The purpose of this meta-analysis was to explore the effect of HT on mental health. Methods We used the PRISMA framework. A keyword search of Web of Science, PubMed, ProQuest and Cochrane was performed. The inclusion criteria were HT with RCTs and mental health assessments. A random-effects model was used to perform the meta-analysis. Results A total of 1,056 records were searched, and 18 eligible studies were extracted. The included RCTs had no statistical heterogeneity and publication bias. The meta-analysis showed that the HT experimental groups had a significant and positive impact on mental health compared with the control groups (effect size = 0.55). Discussion HT should be considered for enhancing mental health. The included studies had no negative outcomes and the most common HT intervention was at least eight sessions. Therefore, HT should be considered to enhance mental health. However, the concealed allocation and blinding processes should be improved in future studies. Implications for Practice: This study recommends that HT should be integrated into healthcare settings to improve mental health.

Epidemiology of depression among displaced people: A systematic review and meta-analysis

INTRODUCTION

Displaced people are prone to develop mental health problems due to resettlement in new environments, traumatic events and forced migration. Depression is a mental health problem repeatedly observed among displaced people such as refugees, migrants, asylum seekers and internally displaced persons (IDPs). Therefore, estimating the global pooled prevalence of depression as well as pinpointing its determinants may support policymakers and health care workers to mitigate the disease burden and improve the psychological well-being of displaced people.

METHODS

PubMed, EMBASE, CINAHIL, Psych-INFO, and SCOPUS databases were searched for English written relevant observational studies conducted between 1984 and 2020. The methodological quality of studies was assessed using the Newcastle Ottawa Scale (NOS). Heterogeneity across studies was checked using the Q- and I² test. Publication bias was checked by observing Funnel plot symmetry and using Egger's regression test. STATA 16 was used to combine studies using a random effect model.

RESULTS

Of the 4102 studies identified, 81 studies with an overall sample size of 53,458 were included in the current systematic review and meta-analysis. The pooled prevalence estimate of depression among displaced people was 26.4% (95% CI; 22.2-31.1). Also, three in five IDPs, one in three refugees and asylum seekers and one in four migrants suffer from depression globally. Being female migrant [AOR: 2.46 95% CI: 1.79-3.13, I²=34.5%), non-partnered marital status [AOR: 2.29, 95% CI: 1.29-3.30, I²= 0.00%], and perceived low social support [AOR: 1.76, 95% CI: 1.00-2.52, I²=34.6%] were significant determinants of depression among displaced people.

CONCLUSION

Overall, around 1 in 4 displaced people suffer from depression and exceed the prevalence of depression reported by community samples in different nations and demonstrate a need for culturally fitting and targeted responses from migrant/refugee host nations and their serving clinicians.

Prevalence of anxiety, depression, and post-traumatic stress disorder after cardiac arrest: A systematic review and meta-analysis

AIM

Quality of life after surviving out-of-hospital cardiac arrest (OHCA) is poorly understood, and the risk to mental health is not well understood. We aimed to estimate the prevalence of anxiety, depression, and post-traumatic stress disorder (PTSD) following OHCA.

METHODS

In this systematic review and meta-analysis, databases (MEDLINE, EMBASE, and PsycINFO) were searched from inception to July 3, 2021, for studies reporting the prevalence of depression, anxiety, and PTSD among OHCA survivors. Data abstraction and quality assessment were conducted by two authors independently, and a third resolved discrepancies. A single-arm meta-analysis of proportions was conducted to pool the proportion of patients with these conditions at the earliest follow-up time point in each study and at predefined time points. Meta-regression was performed to identify significant moderators that contributed to between-study heterogeneity.

RESULTS

The search yielded 15,366 articles. 13 articles were included for analysis, which comprised 186,160 patients. The pooled overall prevalence at the earliest time point of follow-up was 19.0% (11 studies; 95% confidence interval [CI] = 11.0-30.0%) for depression, 26.0% (nine studies; 95% CI = 16.0-39.0%) for anxiety, and 20.0% (three studies; 95% CI = 3.0-65.0%) for PTSD. Meta-regression showed that the age of patients and proportion of female sex were non-significant moderators.

CONCLUSION

The burden of mental health disorders is high among survivors of OHCA. There is an urgent need to understand the predisposing risk factors and develop preventive strategies.

Psychological changes after coronary angiographic intervention: pre-post comparison and follow-up

Epidemiological studies demonstrate the relevance of cardiovascular diseases for health policies and medical care, especially coronary heart diseases and myocardial infarction. Research has shown that a significant proportion of patients undergoing coronary angiography suffer from clinically relevant mental stress. The aim of this study is to investigate to what extent the psychological state of cardiology patients changes in short- and mid-term periods after coronary angiography has been performed. The study design is naturalistic, longitudinal and comparative about consecutively admitted patients undergoing coronary angiography (N = 419; consenting patients fulfilling inclusion criteria n = 68) at four measurement points: before and after angiography and 6 weeks and 6 months after discharge. The statistical analysis includes paired t-tests, chi-square tests, effect sizes and random effects regression models. The sample was representative of the target population. The prevalence of risk factors were: 84% heart attack, 31% diabetes and 84% hypertension. There were no angiographic pathological findings in 12% of the sample. The neuroticism levels of the sample was higher than in the general population. There were almost no pre-post differences for depression, anxiety, psychological well-being, self-efficacy, resilience or locus of control. At the mid-term, well-being and anxiety decreased and internal locus of control increased. Neuroticism was negatively and extraversion and openness were positively associated with mental state and resources. The sample showed persistent adverse subsyndromal depressivity. At the mid-term, patients realised that their prognosis also depends on their own behaviour (internal attribution). Special psychosomatic attention should be given to people with subsyndromal depression, higher emotional instability and those with angina pectoris symptoms displaying normal coronary angiography.

The impact of depression on heart transplant outcomes: A retrospective single-center cohort study

BACKGROUND

Depression is prevalent in patients with heart failure and after heart transplant. We identified the prevalence of pre- and post-transplant depression and its association with clinical characteristics and post-transplant outcomes.

METHODS

We reviewed 114 adults transplanted 1/1/2015 to 12/31/2015 and identified patients with pre- and post-transplant depression. Clinical characteristics and outcomes were compared.

RESULTS

Of 114 patients, 35.1% had pre-transplant depression and 26.3% had post-transplant depression. Patients with post-transplant depression within the first year were significantly more likely to have acute rejection (10% vs 0%), longer intensive care unit (11.7 days vs 7.8 days) and hospital stay (31.7 days vs 16.3 days), and discharge to inpatient rehabilitation (26.7% vs 8.3%). Patients with post-transplant depression within the first year had significantly higher 5-year mortality (30% vs 9.5%, p = .009). However, after adjustment for total artificial heart/biventricular assist device, acute rejection, intensive care unit, and hospital length of stay, this relationship was no longer significant (HR 2.11; 95% CI 0.18-25.27; p = .556).

CONCLUSIONS

Depression is common among heart transplant candidates and recipients. While pre-transplant depression did not impact outcomes, patients with post-transplant depression were more likely to have had a complicated course, suggesting the need for increased vigilance regarding depression in such patients.