February 6, 2009
Psychological Impact Found In Adolescents With Kidney Transplants
A new study describes the psychological profile of adolescents who have received kidney transplants and compares them to those of healthy peers. The findings reveal a significantly higher prevalence of psychiatric conditions (depression, phobia, ADHD), educational impairment and social isolation among adolescents who had undergone a transplant. The study appears in Pediatric Transplantation.
In the transplant group studied, 65 percent were diagnosed with a lifetime psychiatric disorder, compared to 37.5 percent in the control group. Transplant recipients also showed significantly more mood disorders than the control group, nearly twice the frequency of anxiety disorders and more behavioral disorders.
Young adults with childhood kidney conditions also show difficulties in tasks requiring concentration and memory. 22.5 percent of the overall transplant group and 31 percent of boys suffered from ADHD. The prevalence of school problems and learning difficulties also was high; as 30 percent had learning difficulties and 60 percent had repeated at least one school grade.
Compared to other young adults who grew up with a chronic or life-threatening disease (including childhood cancer), kidney disease patients have been shown to have a delay in independent behavior. 37.8 percent of transplant recipients studied had borderline/clinical social competence diagnoses and were found to be more withdrawn and isolated than their peers.
Post-operative treatment after transplantation includes a lifetime of immunosuppressive drugs, clinic visits and intrusive tests such as biopsies. Immunosuppression carries its own risks by causing susceptibility to infection and malignancies, or other side effects.
Non-adherence to this treatment may be as high as 25 percent in adolescent transplant recipients, and carries an additional set of problems. It was found to be associated with higher levels of psychological distress (low self-esteem, depressive symptoms, and behavioral problems).
While many physical, psychological, social and cognitive changes take place in adolescence, regardless of physical condition, adolescents with chronic conditions have lower emotional well-being scores, worry more and have poorer body image. They are more socially isolated and have limited opportunities for psychosexual development and peer relationships. Adolescents with this condition are also more likely to exhibit symptoms of depression.
These symptoms in adolescence strongly predict an episode of major depression in adulthood. Adolescent anxiety and depressive disorders have also been associated with increased frequency of personality disorders and dysfunction in community samples followed-up in young adult life. Adolescents transplant patients may therefore remain at risk of developing psychiatric disorders after they are transferred to the adult care system.
"These dimensions should be routinely screened for in patients, both before and after transplant and appropriate steps should be taken when needed, such as psychiatric/educational support and the promotion of social activities," says Dr. Eric Fombonne, co-author of the study. "Because transplant patients face a lifelong disease and may remain at risk for developing psychiatric disorders, special attention should be paid when transferring their care from pediatric to adult services."
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