Trajectories of anxiety and depression after liver transplantation as related to outcomes during 2-year follow-up: a prospective cohort study

OBJECTIVE: To examine whether distinct trajectories of anxious and depressive symptoms are present among liver transplant recipients from before transplantation to two years afterwards; to identify associated demographic, clinical, and individual characteristics; and to examine the influence of distinct trajectories on outcomes.

METHODS: A prospective, multicenter cohort study was performed among 153 liver transplant recipients. Data were retrieved using questionnaires administered before transplantation and at 3, 6, 12, and 24 months after transplantation. Clinical data were retrieved by medical record review. Latent Class Growth Analysis was used to identify distinct trajectories. Chi-square test, ANOVAs, and multinomial logistic regression were used to identify associated variables and the impact of the distinct trajectories on outcomes.

RESULTS: Three distinct trajectories for symptoms of anxiety (STAI-6) as well as depression (CES-D) were identified: "no symptoms," "resolved symptoms," and "persistent symptoms." The trajectories of persistent anxiety and depression comprised respectively 23% and 29% of the transplant recipients. Several clinical and individual variables were associated with the trajectories of persistent anxiety and/or depression: experiencing more side-effects of the immunosuppressive medication, lower level of personal control, more use of emotion-focused coping, less disclosure about the transplant, and more stressful life events. The trajectories of persistent symptoms were associated with worse outcomes regarding medication adherence and health-related quality of life, but not with mortality.

CONCLUSION: A significant subset of transplant recipients showed persistent symptoms of anxiety and depression from before to two years after transplantation. These results emphasize the importance of psychosocial care in the transplant population.