MAJOR DEPRESSION, ANXIETY, AND LUNG TRANSPLANTATION

重度抑郁、焦虑和肺移植

基本信息

批准号：
6538882
负责人：
Mary Amanda Dew
金额：
$ 36.88万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
1999
资助国家：
美国
起止时间：
1999-09-30 至 2004-05-31
项目状态：
已结题

项目摘要

Survival is only one goal of lung transplantation (txp). Recipients' and their families' long-term psychological adaptation must be considered when evaluating costs and benefits of this therapy. Beyond clinical, accounts, there are no data on the occurrence or course of significant psychiatric disorder among recipients in the post-txp years. There are no data on whether the unique chronic stresses associated with lung txp affect the family caregiver's mental health. Despite assertions that both parties' mental health are critical predictors of recipients' medical compliance and, hence, of their long-term physical health and quality of life, empirical evidence of such effects is lacking. Concerning the latter outcomes, there has been no estimation of Quality-Adjusted Life Years (QUALYs) associated with various health statuses e.g., mental illness noncompliance that emerging post-txp. Consideration of outcomes such as QALYs is a necessary first step toward eventual economic cost effectiveness analyses comparing the impact of such conditions, and attempts to treat or avert them. The study will address clinical epidemiologic questions pertaining to (a) the distribution and course of selected clinical and subclinical psychiatric conditions among recipients and caregivers during the first 2 years post- txp; (b) the impact of post-noncompliance on recipients' ultimate txp- related physical health, quality of life, and QALYS. Face-to-face interviews, electronic medication monitoring, and medical record reviews will be conducted with all adult lung recipients surviving the initial post- txp acute care period at the University of Pittsburgh Medical Center (UPMC) during the study enrollment period (anticipated N=137). Interview will be conducted as recipients return to UPMC for routine follow-up at 2, 6, 12, 18, and 24 months post-txp. For comparison purposes, data will be collected at identical timepoints from a 115 heart recipients transplanted during the study enrollment period, and from a cross-sectional sample of 85 lung txp candidates. Family caregivers of all these persons will be interviewed as well. Interviews will assess depressive and anxiety-related conditions (with the SCID); recipients' medical compliance; perceptions of recipients' physical health; generic and disease-specific components of QOL; and psychosocial characteristics. In addition to electronic medication monitoring during the 2-year period, compliance and health data will be obtained from Txp Program staff evaluations and medical records. An ultimate aim of the analyses is to refine hypotheses about the predictive sequence of effects under investigation and thereby to revise the study's conceptual model for subsequent intervention efforts.

生存仅是肺移植（TXP）的一个目标。在评估这种疗法的成本和收益时，必须考虑接受者及其家人的长期心理适应。除临床外，还没有关于TXP后接受者之间严重精神疾病的发生或过程的数据。没有关于与肺TXP相关的独特慢性压力是否影响家庭护理人员的心理健康的数据。尽管断言双方的心理健康是接受者医疗依从性的关键预测指标，因此缺乏这种影响的经验证据。关于后者的结果，没有估计与各种健康状况相关的质量调整后的终身年份（Qualys），例如，TXP后出现的精神疾病不符合符合性。考虑结果（例如Qalys）是最终经济成本有效性分析的必要第一步，以比较此类条件的影响，并试图治疗或避免它们。该研究将解决与（a）在TXP后的头两年中，接受者和护理人员在接受者和护理人员中选定的临床和亚临床精神病的分布和过程有关的临床流行病学问题；（b）非态度对受体最终TXP相关的身体健康，生活质量和QALY的影响。在研究入学期间，将对所有在匹兹堡大学医学中心（UPMC）的最初的急性急性护理期（预计n = 137）进行面对面访谈，电子药物监测和病历审查。访谈将作为接收者返回UPMC进行常规随访，以在TXP后2、6、12、18和24个月进行。为了进行比较，将在研究入学期间移植的115名心脏受体的相同时间点以及从85个肺TXP候选者的横截面样本中收集数据。所有这些人的家庭护理人员也将接受采访。访谈将评估与抑郁症和焦虑有关的状况（SCID）；接受者的医疗合规；对接受者身体健康的看法； QoL的通用和疾病特异性成分；和社会心理特征。除了在2年期间进行电子药物监测外，合规性和健康数据还将从TXP计划人员评估和医疗记录中获得。分析的最终目的是完善有关所研究效果的预测序列的假设，从而修改研究的概念模型以进行后续干预工作。