Post-traumatic growth and its relationship to quality of life up to 9 years after liver transplantation: a cross-sectional study in Spain

The Relationship Between Spiritual Well-Being and Post-Traumatic Growth in Turkish Patients Undergoing Solid Organ Transplantation

This study was conducted to determine the relationship between spiritual well-being and post-traumatic growth in solid organ transplant patients. This cross-sectional study was conducted with 366 patients who presented to the organ transplantation polyclinic of a university hospital between September 2021 and February 2022 in Turkey. The mean Post-Traumatic Growth Inventory and Spiritual Well-Being Scale scores of solid organ transplant patients were 81.33 ± 20.28 and 37.18 ± 8.69, respectively. There was a significant positive correlation between post-traumatic growth and spiritual well-being. According to linear regression analysis, spiritual well-being, gender, marital status, transplanted organ, donor type, and previous mental disorders were statistically significant predictive factors that affected post-traumatic growth. Spiritual well-being was an important variable that affected post-traumatic growth in solid organ transplant patients. Therefore, healthcare providers can provide individualized psychosocial-spiritual care and counseling services that increase post-traumatic growth in patients after organ transplantation.

Predictors of post traumatic growth in allogeneic hematopoietic stem cell transplantation survivors: a cross-sectional survey

AIMS

Given the increasing number of Hematopoietic Stem Cell Transplantations (HSCT) performed world-wide, the increasing likelihood of survival following HSCT, and the profound physical, psychosocial, and emotional impact of HSCT on survivors, their carers and families, it is important to identify factors that may contribute to or support post-traumatic growth (PTG) after transplant. In this study, we aimed to investigate the prevalence of PTG in an Australian cohort of long-term allogeneic HSCT survivors and describe associations between PTG and relevant clinical, sociodemographic and psychological variables.

METHODS

This was a large, multi-centre, cross sectional survey of Australian HSCT-survivors inviting all those transplanted in New South Wales between 2000 and 2012. Respondents completed the PTG Inventory (PTGI), the Sydney Post-BMT Survey, FACT-BMT, DASS 21, The Chronic Graft versus Host Disease (GVHD) Activity Assessment-Patient Self-Report (Form B), the Lee Chronic GVHD Symptom Scale, and the Fear of Cancer Recurrence Scale. Data was analysed using independent t-tests, one-way analysis of variance, and pearson's correlations, and hierarchical multiple regression adjusted for potential confounders and to ascertain independent associations of explanatory variables with PTG.

RESULTS

Of 441 respondents, 99% reported some level of PTG with 67% reporting moderate to high levels of PTG. Female gender, younger age, complementary therapy use, anxiety, psychological distress and psychosocial care, and higher quality of life were associated with higher levels of PTG. Importantly, we also found that PTG was not associated with either chronic GVHD or post-HSCT morbidity.

CONCLUSIONS

In this study - the largest study of PTG in long-term allogeneic HSCT survivors - we found that growth appears ubiquitous, with 99% of survivors reporting some degree of PTG and 67% reporting moderate-high levels of PTG. Importantly, we found no association with GVHD or chronic physical post-HSCT morbidity, or adverse financial, occupational or sexual impacts. This suggests that it is the necessity for and experience of, HSCT itself that foments personal growth. Accordingly, healthcare professionals should be alert to the profound and wide-ranging impact of HSCT - and the degree to which survivor's may experience PTG. Identifying interventions that may assist HSCT survivors cope and building their resilience is of utmost importance.

The effect of post-traumatic growth on recovery in liver transplant recipients

Aim

In our study, we examined the effect of post-traumatic growth on recovery in liver transplant recipients in the post-transplant period.

Method

This research was performed as a descriptive and cross-sectional study with the participation of 218 patients who had liver transplantation at the liver transplant institute of a research and training hospital. The personal information form, the Post-Traumatic Growth Inventory, and the Recovery Assessment Scale were used in the data collection process. The Statistical Package for Social Science 25.0 was utilized in the data analysis process.

Findings

In the research, of all participant liver transplant recipients, 67.8% were aged 45-64 years, 34.4% had incomes below expenses, and 91.7% had living donor liver transplantation. Besides, it was found that participants who had living donor liver transplantation obtained higher mean scores from both the Post-Traumatic Growth Inventory and the Recovery Assessment Scale than participants who had cadaveric donor liver transplantation, and likewise, participants who had past surgery experiences obtained higher mean scores from both the Post-Traumatic Growth Inventory and the Recovery Assessment Scale than participants who had no past surgery experience (p < 0.05). Moreover, there was a statistically significant positive linear relationship between participant liver transplant recipients' Post-Traumatic Growth Inventory and Recovery Assessment Scale scores.

Conclusion

Post-traumatic growth supports recovery. Also, social support and a good economic situation are other parameters that promote recovery. In the two-year process during which the treatment is intensively applied to liver transplant recipients following the transplantation surgery, it is important to enable patients to find more meaning in life and to find solutions that facilitate recovery.

Active coping, resilience, post-traumatic growth, and psychiatric symptoms among early and late liver transplant survivors

Understanding survivorship experiences at different stages postliver transplantation (poat-LT) is essential to improving care. Patient-reported concepts including coping, resilience, post-traumatic growth (PTG), and anxiety/depression, have been implicated as important predictors of quality of life and health behaviors after LT. We aimed to descriptively characterize these concepts at different post-LT survivorship stages. This cross-sectional study featured self-reported surveys measuring sociodemographic, clinical characteristics, and patient-reported concepts including coping, resilience, PTG, anxiety, and depression. Survivorship periods were categorized as early (1 y or below), mid (1-5 y), late (5-10 y), and advanced (10 y or above). Univariable and multivariable logistic and linear regression modeling examined factors associated with patient-reported concepts. Among 191 adult LT survivors, the median survivorship stage was 7.7 years (interquartile range: 3.1-14.4) and median age was 63 years (range: 28-83); most were male (64.2%) and Caucasian (84.0%). High PTG was more prevalent in the early survivorship period (85.0%) than late survivorship (15.2%). High trait resilience was only reported by 33% of survivors and associated with higher income. Lower resilience was seen among patients with longer LT hospitalization stays and late survivorship stages. About 25% of survivors had clinically significant anxiety and depression, which was more frequent among early survivors and females with pre-LT mental health disorders. In multivariable analysis, factors associated with lower active coping included survivors ≥65 years, non-Caucasian race, lower levels of education, and nonviral liver disease. In a heterogeneous cohort including early and late LT survivors, there was variation in levels of PTG, resilience, anxiety, and depression at different survivorship stages. Factors associated with positive psychological traits were identified. Understanding determinants of LT survivorship has important implications for how we should monitor and support LT survivors.

Post-Traumatic Growth and Quality of Life among World Trade Center Health Registry Enrollees 16 Years after 9/11

A recent study of World Trade Center Health Registry enrollees found that about one-third experienced post-traumatic growth (PTG) in the wake of the 9/11 attacks and that PTG was associated with social support and social integration. However, the implications of PTG for the enrollees' overall quality of life are unknown. The present study investigated the prevalence of PTG and its association with the SF-12 physical and mental functioning quality of life scales in a sample of 4760 enrollees from the Registry's Health and Quality of Life Study (HQoL) who completed the first four surveys, were older than 18 on 9/11, reported English as their primary spoken language, and provided consistent self-report of 9/11 physical injury at the Registry's baseline and HQoL surveys. We employed multivariable linear regression to evaluate the association between PTG and the SF-12 physical and mental scales, controlling for sociodemographic and other variables. We found that 31% of the sample enrollees experienced PTG and that PTG exhibited a clinically and statistically significant association with the SF-12 mental scale but not the physical scale (physical: b = 0.15 (-0.45, 0.75), mental: b = 3.61 (2.85, 4.37)). Those who were physically injured during 9/11 showed larger improvements in mental functioning than those who were not. PTG has implications for the overall mental quality of life that should be further investigated.

Impact of COVID-19 lockdown on mood status: A comparison of hemodialysis and oncology patients

INTRODUCTION

Coronavirus related lockdown measures had a severe psychological toll. We investigated the effects of population-wide infection control measures on hemodialysis (HD) and oncology patients' mood statuses.

METHODS

An electronic survey was used to collect data. We used the Profile of Mood States (POMS) and the Hospital Anxiety and Depression Scale (HADS) to measure the mood statuses.

RESULTS

The study groups composed of 400 HD, 234 oncology patients, and 276 controls. HADS anxiety and total POMS scores were significantly higher in the control group than that of both HD and oncology patients, a finding consistent with a worse mood status. In multivariate models, the male gender and the perception of having received appropriate medical support during the pandemic period were independent predictors of better POMS and HADS-anxiety and depression scores.

CONCLUSION

HD and oncology patients appear to be less affected by the psychological stress induced by social distancing and lockdown periods.

Beyond the Boundaries of Disease—Significant Post-traumatic Growth in Multiple Sclerosis Patients and Caregivers

Despite the negative repercussions of a chronic disease, multiple sclerosis (MS) might also lead to positive consequences. This longitudinal study explored post-traumatic growth in MS patients and attempted to identify possible determinants. Post-traumatic growth of 260 patients and their caregivers was compared. A subset of 209 patients and caregivers were evaluated at baseline. Patients filled in the Posttraumatic Growth Inventory and General Health Questionnaire at three different times over a 36-month follow-up period. Patient post-traumatic growth significantly increased over the follow-up period (p &lt; 0.001) with large effect sizes on almost every subscale. Higher score on the Expanded Disability Status Scale, higher pain severity, female gender, and higher anxiety were positive predictors of post-traumatic growth, while more interference of pain, higher level of education, and more social dysfunction were negative predictors. Post-traumatic growth did not differ significantly between patients and caregivers. Our results showed significant positive intrapsychic changes of MS patients over a 36-month follow-up period up to 12 years from diagnosis. The potential influence of clinical, demographic, and mental health variables underlines the need for a personalized approach to be able to understand and sustain these processes. Comparable post-traumatic growth levels in patient-caregiver dyads at baseline suggest interdependently driven cognitive processes stabilizing well-being. Future research is recommended for further insight into the underlying cognitive processes.

Perceived social support associated with posttraumatic growth in liver transplant recipients: A cross-sectional study

INTRODUCTION

There is almost no information about the role of perceived social support, one of the main variables facilitating posttraumatic growth, in liver transplant. For this reason, the issue requires further clarity. The aim of this study was to investigate the relationship between perceived social support and posttraumatic growth in individuals receiving liver transplants.

METHOD

This cross-sectional study was carried out with liver transplant recipients at a hospital in eastern Turkey (N = 117). The data collection instruments included a Descriptive Characteristics Form, the Posttraumatic Growth Inventory and the Multidimensional Scale of Perceived Social Support. The data were analyzed using descriptive statistics, correlation analysis and hierarchical linear regression analysis.

RESULTS

It was revealed that the participants had high levels of posttraumatic growth (73.05 ± 16.82) and perceived social support (67.75 ± 14.33). A moderate and positive relationship was determined between the mean perceived social support total score and the mean posttraumatic growth total score of the participants (p < 00.01). Perceived social support explained 25.6% of the variance in posttraumatic growth (F = 39.600; p < 0.05; Adjusted R²=0.256), while perceived social support together with primary school-level education and low economic status explained 32.3% of the variance in posttraumatic growth (F = 17.954; p < 0.05; Adjusted R²=0.323).

CONCLUSION

The results on perceived social support revealed that liver transplant recipients had a subjective feeling of being understood, respected and supported by their families more than friends and significant other in a social environment. This study showed that high perceived social support contributes to posttraumatic growth in liver transplant recipients. Apart from perceived social support, other factors affecting posttraumatic growth included individuals' perceptions of their education level and economic situation.

Factors associated with posttraumatic growth among healthcare workers at an academic-medical center: A correlational study

PURPOSE

Posttraumatic growth (PTG) can occur after experiencing traumatic events. Our purpose was to examine factors associated with PTG experiences of healthcare workers within an academic-medical center.

DESIGN AND METHODS

A correlational study was conducted using a convenience sample of 479 healthcare workers at a large academic-medical center.

FINDINGS

Having children living at home, serving the pediatric population, longer duration of alcohol abstinence, and having received treatment for trauma were significantly associated with greater PTG scores. Compared to nondirect care staff, advance practice providers, nursing staff, social work/psychologists, and pharmacy staff had significantly lower PTG scores.

PRACTICE IMPLICATIONS

Understanding the positive psychological changes that occur in workers after trauma experiences may provide insight to guide interventions that promote healthcare worker wellbeing.

Posttraumatic Growth in Youth, Young Adults, and Caregivers Who Experienced Solid Organ Transplant

OBJECTIVE

To explore posttraumatic growth (PTG) in pediatric patients who have undergone solid organ transplant (SOT) and their caregivers, and to examine potential correlates of PTG.

METHOD

Youth and young adults with a history of SOT (heart, kidney, liver) at least 1 month prior to participation and caregivers completed measures of PTG, demographic, and medical factors. In total, 59 youth (M = 12.68 years, SD = 1.91), 21 young adults (M = 19.37, SD = 0.82), and 95 caregivers (M = 37.95 years, SD = 9.37) participated.

RESULTS

Overall, 67% of youth, 76% of young adults, and 89% of caregivers reported PTG within the medium to very high range. Appreciation of Life was the highest PTG subscale across all groups. Youth and caregiver PTG scores were significantly positively correlated. Religious affiliation and religious coping were positively associated with PTG for caregivers, and the relationship yielded large effect sizes for young adults. Caregivers of children with kidney transplants endorsed lower PTG than other organ types and caregivers of children who had an acute medical condition endorsed greater PTG than caregivers of children who had chronic illness.

CONCLUSION

Findings suggest the pediatric SOT experience can yield positive changes such as a greater appreciation of life. Although small sample sizes may have led to reduced power for detecting significant findings for some analyses, results suggest religious, medical, and parent-child relationship factors are likely related to PTG in pediatric SOT and warrant future investigation.

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.

Post-Traumatic Growth among Older People after the Forced Lockdown for the COVID-19 Pandemic

We explored post-traumatic growth (PTG) in older adults immediately after the forced lockdown in Spain during March to April, 2020, due to the COVID-19 pandemic. The study also tried to identify the variables that predict PTG, focusing on the experience of COVID, sociodemographic variables, and social resources. In total 1,009 people aged 55 years and older participated in the study and completed an online questionnaire comprising the following elements: The short form of the Post-traumatic Growth Inventory (PTGI-SF), sociodemographic and social resources questions, and their experiences of COVID-19 (if they had been infected themselves or if they had experienced the loss of someone close). Results showed that only a quarter of the participants experienced higher PTG after the forced lockdown, with only age and social resources being correlated with scores on the PTGI-SF. Looking at the strengths that older adults put into action to combat the pandemic and its social and health consequences could be an important consideration when planning future social policies for this and other pandemics.

Transplant-related trauma, personal growth and alcohol use outcomes in a cohort of patients receiving transplants for alcohol associated liver disease

BACKGROUND

Liver transplantation (LT) is stressful experience which can cause psychological trauma but also positive growth. We examined the prevalence of transplant related post-traumatic stress disorder symptoms (PTSD) and post-traumatic growth (PTG) in a cohort of alcohol-associated liver disease (ALD) LT recipients. We also examined whether PTG or PTSD symptoms were associated with post-LT alcohol use.

METHODS

Cross sectional survey of 51 ALD LT recipients one-year post-LT assessed PTSD symptoms, PTG, stress, self-efficacy, social support, and alcohol use.

RESULTS

18% endorsed symptoms of PTSD; 59% endorsed high PTG. PTSD symptoms and PTG were not associated. 18% drank alcohol; 10% returned to health harmful use. Neither PTSD symptoms nor PTG were associated with alcohol use. Less self-efficacy to abstain and thoughts of drinking were associated with alcohol use.

CONCLUSIONS

A substantial percentage of ALD LT patients had transplant-related PTSD symptoms and high PTG. Alcohol use was not associated with PTSD symptoms or PTG. Lower self-efficacy to abstain from alcohol use may provide a valuable clinical measure to assess risk for post-LT use. Clinical screening for PTSD would be beneficial as effective treatments for PTSD exist. Whether PTG can be facilitated in transplant recipients would be a valuable future line of inquiry.

Coronavirus Pandemic: Mood Statuses of Renal Transplant Recipients During Social Isolation and Lockdown Periods

OBJECTIVES

In an attempt to control the new coronavirus pandemic, many countries have taken unprecedented measures, such as extensive social distancing and total lockdowns of cities. Kidney transplant recipients have an increased risk for infectious diseases, including viral infections. In this study, we aimed to investigate the effects of population-wide infection control measures on the mood statuses of kidney transplant recipients.

MATERIALS AND METHODS

We used an electronic survey tool to collect demographic and sociocultural data. Additionally, in the same survey, we used 2 questionnaires (the Profile of Mood States and the Hospital Anxiety and Depression Scale) to measure mood statuses of kidney transplant recipients. We also examined a control group and selected eligible participants according to age- and sex-based propensity score matching.

RESULTS

We analyzed the data of 308 participants: 154 kidney transplant recipients (mean age of 39.9 ± 10.6 years; 57.1% male) and 154 control participants (mean age of 39.1 ± 10.5; 57.1% male). With regard to the Profile of Mood States questionnaire, total scores and all subscale scores, excluding vigor, were significantly lower in kidney transplant recipients than in the control group, a finding consistent with a better mood status. We found similar findings in anxiety and depression scores for the Hospital Anxiety and Depression Scale questionnaire.

CONCLUSIONS

Kidney transplant recipients seem to be resilient to the psychological stress induced by social distancing and lockdown periods. Strict adherence to infection control measures is purposefully suggested in this infection-prone population.

Factors associated with health-related quality of life in kidney transplant recipients in Korea

Health-related quality of life (HRQOL) of kidney transplant recipients is an outcome evaluation after kidney transplants. Therefore, we investigated the associations among perceived health status, social support, self-determination, post-traumatic growth, and kidney transplant recipients' HRQOL. This study involved a descriptive, self-report survey of 163 kidney transplant recipients visiting an outpatient solid organ transplant center in South Korea. Participants' general and transplant characteristics, perceived health status, post-traumatic growth, social support, self-determination, and HRQOL were collected. Data were statistically analyzed using the software SPSS version 25.0. HRQOL showed statistically significant positive correlation with perceived health status (r = .56, p < .001), post-traumatic growth (r = .18, p = .022), social support (r = .25, p = .002), and self-determination (r = .36, p < .001). The factors affecting HRQOL were perceived health status (β = 0.47, p < 0.001), post-transplant occupation (β = 0.17, p = 0.009), and income source (β = -0.13, p = 0.046). The explanatory power of these variables was 34.8% (F = 28.81, p < 0.001). In the subdomains of HRQOL, the factors influencing HRQOL of mental component summary were perceived health status (β = 0.45, p < 0.001), self-determination (β = 0.27, p < 0.001), and education level (β = 0.18, p = 0.006). The explanatory power of these variables was 34.8% (F = 28.81, p < 0.001). To promote the HRQOL of kidney transplant recipients, an institutional system to assist kidney transplant recipients in returning to work needs to be developed. Additionally, creating an environment that allows kidney transplant recipients to act with self-determination, and developing intervention programs that can enhance self-determination will contribute to enhancing the HRQOL of kidney transplant recipients.

Psychosocial dimensions of hand transplantation: lessons learned from solid organ transplantation

PURPOSE OF REVIEW

The present review examines psychosocial factors emerging as predictive of clinical outcomes among solid organ transplant (SOT) recipients, with possible extensions to vascular composite allograft (VCA) and hand transplantation, in particular. The Chauvet Workgroup report and International Society of Heart and Lung Transplantation consensus guidelines are used to delineate areas of commonality between SOT and VCA, as well as unique features contributing to post-VCA psychosocial risk.

RECENT FINDINGS

Increasing evidence suggests that depression, cognitive function, and other posttransplant psychosocial factors consistently associate with clinical risk in SOT. However, the mechanisms precipitating these psychosocial risk factors are likely diverse in their cause, with large individual differences across SOT and VCA. Transdiagnostic dimensions may serve as mechanistic factors, increasing the risk of adverse clinical outcomes and suggesting potential treatment strategies for risk mitigation. Psychosocial dimensions including psychological flexibility, self-efficacy, and posttraumatic growth are discussed as potential contributory factors.

SUMMARY

Psychosocial factors hold importance in predicting posttransplant clinical outcomes. Emerging transdiagnostic factors may provide insight into mechanisms and potential treatments.

Post-traumatic growth in mental health recovery: qualitative study of narratives

OBJECTIVES

Post-traumatic growth, defined as positive psychological change experienced as a result of the struggle with challenging life circumstances, is under-researched in people with mental health problems. The aim of this study was to develop a conceptual framework for post-traumatic growth in the context of recovery for people with psychosis and other severe mental health problems.

DESIGN

Qualitative thematic analysis of cross-sectional semi-structured interviews about personal experiences of mental health recovery.

SETTING

England.

PARTICIPANTS

Participants were adults aged over 18 and: (1) living with psychosis and not using mental health services (n=21); (2) using mental health services and from black and minority ethnic communities (n=21); (3) underserved, operationalised as lesbian, gay, bisexual and transgender community or complex needs or rural community (n=19); or (4) employed in peer roles using their lived experience with others (n=16). The 77 participants comprised 42 (55%) female and 44 (57%) white British.

RESULTS

Components of post-traumatic growth were present in 64 (83%) of recovery narratives. Six superordinate categories were identified, consistent with a view that post-traumatic growth involves learning about oneself (self-discovery) leading to a new sense of who one is (sense of self) and appreciation of life (life perspective). Observable positively valued changes comprise a greater focus on self-management (well-being) and more importance being attached to relationships (relationships) and spiritual or religious engagement (spirituality). Categories are non-ordered and individuals may start from any point in this process.

CONCLUSIONS

Post-traumatic growth is often part of mental health recovery. Changes are compatible with research about growth following trauma, but with more emphasis on self-discovery, integration of illness-related experiences and active self-management of well-being. Trauma-related growth may be a preferable term for participants who identify as having experienced trauma. Trauma-informed mental healthcare could use the six identified categories as a basis for new approaches to supporting recovery.

TRIAL REGISTRATION NUMBER

ISRCTN11152837.

Relationship Between Self-Perceived Health, Vitality, and Posttraumatic Growth in Liver Transplant Recipients

Our objective was to analyze the differences in posttraumatic growth in 240 liver transplant recipients based on two factors. First, self-perceived health: better (Group 1 = G1) and worse (Group 2 = G2). Second, vitality: more (Group 3 = G3) and less (Group 4 = G4). The Posttraumatic Growth Inventory, SF-36 Health Survey (Item 2) and SF-12 Health Survey (vitality dimension) were used. Firstly, analyzing main effects recipients with better (G1) compared to worse (G2) self-perceived health, showed greater posttraumatic growth. Interaction effects were found on essential posttraumatic growth domains such as new possibilities (p = 0.040), personal strength (p = 0.027), and appreciation of life (p = 0.014). Statistically significant differences showed that among transplant recipients with worse self-perceived health (G2), those with more vitality had higher levels on abovementioned posttraumatic growth dimensions. However, in transplant recipients with better self-perceived health (G1) respective dimensions were not significantly influenced by the level of vitality. Among the recipients with less vitality (G4), those with better self-perceived health showed higher scores on abovementioned posttraumatic growth dimensions. We conclude that positive self-perceived health might compensate for a lack of vitality as well as a high level of vitality may compensate for negative self-perceived health regarding the development of crucial aspects of posttraumatic growth after liver transplantation.

The prevalence of moderate-to-high posttraumatic growth: A systematic review and meta-analysis

BACKGROUND

Posttraumatic growth (PTG) is positive psychological changes after encountering challenging events. The main purpose of this meta-analysis was to summarize the prevalence of moderate-to-high PTG in people who experienced traumatic events and to understand what social-demographic and trauma characteristics distinguish those who show a high rate of PTG from those of low level.

METHODS

Six electronic databases were searched. Loney's appraisal criteria were used to evaluate the quality of studies. Freeman-Turkey double arcsine transformation method was used to calculate the combined prevalence. Age, time since event, type of trauma and trauma form were analyzed as subgroup factors. According to the source of the trauma, the type of trauma was divided into three different categories: disease, accident and specific profession. Specific profession refers to firefighters, veterans, intensive care staff, etc. The complex working environment, irregular lifestyle, various unpredictable factors, as well as the frequently adverse stimuli from others contribute to great physical and mental pressure.

RESULTS

Twenty-six articles were deemed as qualified for this systematic review and meta-analysis. The level of PTG across studies ranged from 10% to 77.3%, and heterogeneity tests showed high heterogeneity (I²= 92.3%, 95%CI = 90.1%-94.0%, p < 0.01). Random effect model was chosen to calculate the combined prevalence and the prevalence was 52.58% (95%CI = 48.66%-56.48%). People whose age was younger than 60,had shorter time since trauma,worked in a specific profession and suffered from direct trauma reported high rate of moderate-to-high PTG.

LIMITATIONS

Because the included studies haven't provided adequate PTG-related information, these factors could not be used to performed subgroup analyses. In addition, some studies were excluded due to the different standard may lead to deviation of the combined prevalence.

CONCLUSIONS

Nearly half of the investigated individuals reported moderate-to-high PTG after experiencing a traumatic event. Future research needs to further study the determinants of PTG to provide relevant interventions for the victims of trauma.

Long-Term Outcomes After Extracorporeal Life Support for Acute Respiratory Failure

OBJECTIVE

This study aims to determine the prevalence of functional and psychological impairment in survivors of extracorporeal life support (ECLS) and assess the needs of survivors to guide development of an effective follow-up program.

DESIGN

This mixed-methods outcomes study used quantitative assessment via standardized instruments (Katz Index of Independence of Activities of Daily Living [Katz ADL], the Lawton Instrumental Activities of Daily Living [Lawton IADL], Hospital Anxiety and Depression Scale, and the Post Traumatic Growth Inventory) and qualitative interview to identify challenges experienced by survivors.

SETTING

A single institutional experience in an academic medical center in the United States.

PATIENTS

Patient selection targeted patients who underwent veno-venous ECLS for acute respiratory failure between January 1, 2015, and April 1, 2017. Forty-two patients (21 male, 21 female; median age of 49 years; interquartile range 36-57 years) completed the interview a median of 14.6 (interquartile range 7.7-21.1) months after ECLS decannulation.

INTERVENTIONS

This was an observational follow-up study for which no intervention was made.

MEASUREMENTS AND MAIN RESULTS

The Katz ADL and Lawton IADL revealed high independence and functionality in 62% of patients (26 of 42). Clinically significant anxiety was present in 48% (20 of 42) of patients and depression in 26% (11 of 42). There was a correlation between the number of ADL and IADL deficiencies and depression (rho 0.61, p < 0.001) and anxiety (rho 0.29, p = 0.033) subscales of the Hospital Anxiety and Depression Scale. High levels of posttraumatic growth were noted in 50% (21 of 42) of patients. Nearly all survivors noted that a clinic designed for post-ECLS follow-up would be beneficial. Patients desired access to education, improved coordination of care, and additional mental health resources.

CONCLUSIONS

This study demonstrated persistent physical and psychological impairments in survivors of ECLS. Patients consistently expressed a desire to debrief on their hospital course and receive education on possible long-term effects. Study findings suggest that structured follow-up may allow for early identification of psychological and physical impairments to improve outcomes. Future studies should focus on investigating the effect of rehabilitation and follow-up clinics in preventing these issues.

A Longitudinal Investigation of Posttraumatic Growth and Quality of Life in Liver Transplant Recipients

Background:

What does it mean to adjust to a liver transplant? Quality of life research has offered an impairment model, defining adjustment as the absence of diagnosed psychological disorder or of limitations in physical functioning. Recently emerging research on posttraumatic growth testifies the prevalence of positive life changes following the life-threatening illnesses. The present study aimed to verify the presence of the posttraumatic growth process in liver transplant patients and its relationship with traditional quality of life.

Methods:

The research was a longitudinally descriptive study. A sample of 233 liver transplant patients were assessed with the Posttraumatic Growth Inventory and the Functional Assessment of Chronic Illness Therapy General.

Results:

Over 50% of patients showed moderate-high levels in all dimensions of the Posttraumatic Growth Inventory. Further posttraumatic growth is correlated with the functional and social dimensions of quality of life construct and not with physical and emotional functioning.

Conclusion:

These results confirmed that posttraumatic growth is related to a different definition of well-being than the one traditionally used in the assessment of quality of life. Adjustment to liver transplant is a complex and systemic process, which requires a multidisciplinary approach to be able to support and encourages adaptation through all the needed functional elements. An interesting perspective is offered by the narrative medicine approach, that highlighted the importance to pay specific attention to the words and expression used by patients related to changes in life and not only to traditional words reporting physical status.

Spanish Adaptation and Validation of the Transplant Effects Questionnaire (TxEQ-Spanish) in Liver Transplant Recipients and Its Relationship to Posttraumatic Growth and Quality of Life

The valid assessment of the impact of transplantation on psychological well-being is highly relevant to optimize treatment. However, to date there is no standardized instrument available in Spain. The Transplant Effects Questionnaire (TxEQ) evaluates the specific problems associated with organ transplantation, such as worry about transplant, guilt regarding the donor, disclosure of having undergone transplantation, adherence to medical treatment and responsibility toward the donor, family, friends, or medical staff. Against this backdrop the English original version of the TxEQ was translated into Spanish and validated in a sample of 240 liver transplant recipients. Participants also filled in the Posttraumatic Growth Inventory (PTGI), and the 12-Item Short Form Health Survey (SF-12v.2). Confirmatory factor analysis of the TxEQ-Spanish revealed a five-factor structure equivalent to the English original version, and satisfactory internal consistency (Cronbach's alpha: worry α = 0.82, guilt α = 0.77, disclosure α = 0.91, adherence α = 0.82, responsibility α = 0.83). Results showed that better mental quality of life was associated with higher adherence and disclosure, as well as less worry and guilt. Higher posttraumatic growth was significantly associated with worry, guilt, and responsibility. Interestingly, the most powerful predictor of posttraumatic growth was worry. Analysis of variance showed an interaction effect of PTG and mental quality of life on adherence, with medium PTG being associated with significantly stronger adherence in participants with better mental quality of life. In conclusion our study could successfully adapt and validate the Spanish version of the TxEQ in a large sample of liver transplant recipients. Our findings show a complex relationship between emotional reactions to transplantation, mental quality of life, and posttraumatic growth, which give further insight into inner processes supporting psychological well-being and adherence after liver transplantation.