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Hinton-Froese KE, Teh L, Henderson DR, Hage CA, Chernyak Y. Associations between the stanford integrated psychosocial assessment for transplant and one-year lung transplant medical and psychosocial outcomes. J Behav Med 2024; 47:102-110. [PMID: 37306859 PMCID: PMC10258482 DOI: 10.1007/s10865-023-00427-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/30/2023] [Indexed: 06/13/2023]
Abstract
The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized measure of the psychosocial risk profile of solid organ transplant candidates. While studies have found associations between this measure and transplant outcomes, to date this has not been examined in lung transplant recipients. We examined relations between pre-transplant SIPAT scores and 1-year lung transplant medical and psychosocial outcomes in a sample of 45 lung transplant recipients. The SIPAT was significantly associated with 6-minute walk test (χ2(1) = 6.47, p = .010), number of readmissions (χ2(1) = 6.47, p = .011), and mental health services utilization (χ2(1) = 18.15, p < .001). It was not a significantly associated with the presence of organ rejection or mortality (ps > 0.10). Results suggest that the SIPAT can help identify patients who are at an elevated risk for transplant complications and thus would benefit from services to mitigate risk factors and improve outcomes.
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Affiliation(s)
- Kendra E Hinton-Froese
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 4620246202, USA.
| | - Lisa Teh
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, 10461, The Bronx, NY, USA
- Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, 10461, The Bronx, NY, USA
| | - Danielle R Henderson
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 4620246202, USA
| | - Chadi A Hage
- Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Transplant, University of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 4620246202, USA
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Teh L, Henderson D, Hage C, Chernyak Y. Interitem Psychometric Validation of the Stanford Integrated Assessment for Transplant Scale Among Thoracic Transplant Candidates. J Acad Consult Liaison Psychiatry 2023; 64:418-428. [PMID: 36521680 DOI: 10.1016/j.jaclp.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 10/14/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Psychosocial evaluations are mandatory for transplant listing, however the methodology for creating psychosocial risk stratifications is unclear. The Standford Psychosocial Integrated Psychosocial Assessment for Transplant Scale is the most commonly used instrument, however its interitem validity has never been examined. OBJECTIVE To investigate the interitem validity of a psychosocial assessment tool for transplant candidates among a sample of thoracic transplant candidates. METHODS Clinic data consisting of Stanford Integrated Psychosocial Assessment for Transplant administrations from 173 heart and lung transplant candidates were fit to a partial credit model. Data were subsequently fit to 4 separate partial credit models based on subscale categories, demonstrating the discrimination parameter estimate of each item. Differential item functioning analyses were conducted on the data within each subscale by sex to investigate potential bias produced by each item. RESULTS The initial partial credit model using the full scale did not converge, indicating the subscales possibly did not measure the same underlying construct. Subscale discrimination parameter estimates demonstrated that most items were adequately or highly discriminative. The item measuring history of substance use demonstrated poor fit and differential item functioning. CONCLUSIONS While the Stanford Integrated Psychosocial Assessment for Transplant has demonstrated strong potential as a standardized framework for psychosocial assessments in transplant, this study identified some areas for improvement in the scoring system. The subscale scores appeared to show greater construct validity when utilized individually than when aggregated to form a total score. The substance use/abuse/dependence item did not fit well into its respective subscale. Future studies should aim to optimize the scoring system and re-asses its construct validity to improve its accuracy in discriminating between high-risk candidates and those needing psychosocial assistance.
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Affiliation(s)
- Lisa Teh
- Montefiore Medical Center, Department of Psychiatry and Behavioral Sciences, Bronx, NY; Albert Einstein College of Medicine, Department of Psychiatry and Behavioral Sciences, Bronx, NY; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN.
| | - Danielle Henderson
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
| | - Chadi Hage
- Department of Pulmonology, Allergy, and Critical Care, Indiana University, Indianapolis, IN
| | - Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN
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Chernyak Y, Henderson DR, Teh L, Powell AL, Hinton KE, Hage CA. Characterization of the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) in Lung Transplant Candidates. J Clin Psychol Med Settings 2021; 29:137-149. [PMID: 34043137 DOI: 10.1007/s10880-021-09788-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2021] [Indexed: 01/27/2023]
Abstract
The SIPAT is a standardized measure for pre-transplant psychosocial evaluation. Previous SIPAT studies utilized a relatively small lung transplant sample and only included listed patients. This study characterized the SIPAT in 147 lung transplant candidates to better elucidate its utility. The average score corresponded to a minimally acceptable rating and nearly half of the patients had relative or absolute contraindications. Interstitial Lung Disease (ILD) patients scored more favorably than non-ILD patients (U = 7.69, p < .05). The Total (β = - .05, SE = .018, p < .01), Social Support Subscale (β = - .133, SE = .058, p < .05), and Psychosocial Stability and Psychopathology Subscale (β = - .103, SE = .040, p < .05) significantly predicted listing status. The SIPAT has a unique profile in lung transplant candidates and demonstrated utility for guiding transplant decisions. Future research should examine which lung transplant outcomes are significantly associated with SIPAT scores.
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Affiliation(s)
- Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 46202, USA
| | - Danielle R Henderson
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 46202, USA
| | - Lisa Teh
- Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, The Bronx, NY, USA
| | - Anna-Leigh Powell
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Kendra E Hinton
- Department of Psychiatry, Indiana University School of Medicine, 355 W. 16th St, Indianapolis, IN, 46202, USA.
| | - Chadi A Hage
- Department of Pulmonary Critical Care and Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
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Chernyak Y, Teh L, Henderson DR, Patel A. Practice Issues for Evaluation and Management of the Suicidal Left Ventricular Assist Device Patient. Prog Transplant 2019; 30:63-66. [PMID: 31876252 DOI: 10.1177/1526924819893300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is a high prevalence of depression among left ventricular assist device patients, who present with an increased risk of suicidality given access to means via the device either with nonadherence or disconnection. Suicidality via device nonadherence/disconnection is an underresearched clinical issue, as paradoxically this life-saving procedure can also provide a method of lethal means to patients with significant mental health concerns. A case study is used to highlight the course of an attempted suicide by ventricular assistive device nonadherence. Clinical implications and recommendations for practice include a thorough psychological evaluation presurgery, monitoring quality of life and coping styles before and after placement, psychological testing, outlining specific suicide protocols, psychiatric care considerations for patients with highly specialized medical devices, and related ethical concerns.
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Affiliation(s)
- Yelena Chernyak
- Department of Psychiatry, Indiana University School of Medicine, IU Health Neurosciences Center, Indianapolis, IN, USA
| | - Lisa Teh
- Department of Psychiatry, Indiana University School of Medicine, IU Health Neurosciences Center, Indianapolis, IN, USA
| | - Danielle R Henderson
- Department of Psychiatry, Indiana University School of Medicine, IU Health Neurosciences Center, Indianapolis, IN, USA
| | - Anahli Patel
- Department of Psychiatry, Indiana University School of Medicine, IU Health Neurosciences Center, Indianapolis, IN, USA
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Teh L, Pirkle C, Furgal C, Fillion M, Lucas M. Psychometric validation of the household food insecurity access scale among Inuit pregnant women from Northern Quebec. PLoS One 2017; 12:e0178708. [PMID: 28614392 PMCID: PMC5470676 DOI: 10.1371/journal.pone.0178708] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 05/17/2017] [Indexed: 11/26/2022] Open
Abstract
Background Globally, food insecurity is a major public health concern. In North America, it is particularly prevalent in certain sub-groups, including Indigenous communities. Although many Indigenous and remote communities harvest and share food, most food security assessment tools focus on economic access. This study describes the psychometric evaluation of a modified Household Food Insecurity Access Scale (HFIAS), developed for mixed economies, to assess food insecurity among pregnant Inuit women. Methods The HFIAS was administered to 130 pregnant women in Nunavik (Arctic region of Quebec), Canada. Data were fit to a Rasch Rating Scale Model (RSM) to determine the discrimination ability of the HFIAS. Person parameter (Theta) estimates were calculated based on the RSM to provide a more accurate scoring system of the modified HFIAS for this population. Theta values were compared to known correlates of food insecurity. Results Comparative fit indices showed preference for a modified version of the HFIAS over the original. Theta values displayed a continuum of severity estimates and those values indicating greater food insecurity were consistently linked to known correlates of food insecurity. Participants living in households with more than 1 hunter (Theta = -.45) or more than 1 fisher (Theta = -.43) experienced less food insecurity than those with no hunters (Theta = .48) or fishers (Theta = .49) in their household. The RSM indicated the scale showed good discriminatory ability. Subsequent analyses indicated that most scale items pertain to the classification of a household as moderately food insecure. Conclusions The modified HFIAS shows potential for measuring food insecurity among pregnant women in Nunavik. This is an efficient instrument that can inform interventions targeting health conditions impacting groups that obtain food through both monetary and non-monetary means.
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Affiliation(s)
- Lisa Teh
- Psychology Department, University of Hawai`i at Mānoa, Honolulu, Hawaii, United States of America
- Office of Public Health Studies, University of Hawai`i at Mānoa, Honolulu, Hawaii, United States of America
| | - Catherine Pirkle
- Office of Public Health Studies, University of Hawai`i at Mānoa, Honolulu, Hawaii, United States of America
| | - Chris Furgal
- Indigenous Environmental Studies and Sciences, Trent University, Peterborough, Ontario, Canada
| | - Myriam Fillion
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval, St-Sacrement Hospital, Québec, Québec, Canada
| | - Michel Lucas
- Population Health and Optimal Health Practices Research Unit, CHU de Québec - Université Laval, St-Sacrement Hospital, Québec, Québec, Canada
- Department of Social and Preventive Medicine, Université Laval, Québec, Québec, Canada
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