Psychiatric Morbidity Late Post Heart Transplant

心脏移植术后晚期精神疾病发病率

• 批准号: 7095163
• 负责人: Mary Amanda Dew
• 金额: $ 19.45万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-07-15 至 2009-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7095163
• 关键词: aging; anxiety; behavioral /social science research tag; behavioral medicine; caregivers; clinical research; data collection methodology /evaluation; depression; functional ability; heart transplantation; human morbidity; human subject; interview; longitudinal human study; medical records; mental health; outcomes research; physical fitness; physiologic stressor; postoperative state; prognosis; psychological stressor; questionnaires; social psychology; statistics /biometry; therapy compliance

DESCRIPTION (provided by applicant): Heart transplantation (txp) exemplifies a high-technology biomedical intervention that is extremely costly in terms of economic and health care resources, yet provides highly-valued outcomes: it yields a dramatic extension of duration of life, and marked improvement in quality of life. Like many other major life-extending interventions, however, heart txp brings its own consequent stressors and morbidities. Most critically, it gives patients only a limited extension in life expectancy, usually far less than that based on chronological age. As the population of heart recipients grows, an expanding number of individuals will enter the late years of txp survivorship and face the inevitable physical deterioration that comes during these years. The psychological consequences of late term survivorship are unknown. In this application, we provide the economic, conceptual, and public health rationales for the need to consider these consequences at this time and in this population. There are no data on the nature or course of psychiatric morbidity that may accompany physical health declines, despite the potential impact of such psychiatric morbidity on txp recipients' quality of life and survival time. There are no data on whether the mental health of the patient's primary family caregiver is affected by late-term txp-related health changes. These data, plus identification of factors that create vulnerability or increase psychological resilience in the face of growing physical challenges for the patient will provide the critical knowledge base for the design of mental health interventions for both patients and caregivers during these years. We previously enrolled and followed the only cohort of heart recipients (n=250) ever to have received repeated, extensive psychiatric, behavioral, and psychosocial assessments across the early to middle (0-4) years posttxp. Their family caregiver's mental health and psycho-social status was also assessed. We plan to reassess all cohort survivors (n=132) and their caregivers. At study inception, the bulk of patients will be 9-13 years post-txp. We will collect 3 new waves of data separated by 1 year each in order to address a series of clinical epidemiologic questions pertaining to: (a) the prevalence of depressive and anxiety-related disorders during the late years post-txp, (b) the degree to which patients' and caregivers' risk for psychiatric morbidity in the face of late post-txp physical health stressors is moderated by key psychosocial characteristics, and (c) whether both parties' mental health, in turn, influences patients' continued medical compliance and subsequent physical morbidity. Data collection will involve semi-structured interviews, Txp Program staff evaluations, and medical record reviews.

描述（由申请人提供）：心脏移植（TXP）例证了一种高科技生物医学干预措施，在经济和医疗保健资源方面的成本非常昂贵，但提供了高度评价的结果：它产生了巨大的生活延长，并在生活质量上得到了明显改善。但是，像许多其他延长生命的干预措施一样，心脏TXP带来了其自身的压力和病态。最关键的是，它仅给患者提供预期寿命的有限延长，通常远低于基于年龄的年龄。随着心脏接收者的人口的成长，数量不断扩大的人将进入TXP幸存者，并面临这些年来不可避免的身体恶化。 晚期生存的心理后果尚不清楚。在此应用程序中，我们提供了经济，概念和公共卫生正直的原理，以考虑此时和在这个人群中的这些后果。尽管这种精神病发病率对TXP接受者的生活质量和生存时间产生了潜在的影响，但没有关于精神病发病率的性质或过程的数据。没有关于患者初级家庭护理人员的心理健康是否受到晚期TXP相关的健康变化的影响的数据。这些数据，以及在面对患者的身体挑战日益增加的情况下造成脆弱性或增加心理韧性的因素，将为这些年来为患者和护理人员设计心理健康干预措施的关键知识库。 我们以前曾入学并遵循唯一的心脏接受者（n = 250），在TXP后早期至中期（0-4）年中，我们都接受了反复的，广泛的精神病，行为和社会心理评估。还评估了他们家庭护理人员的心理健康和心理社会状况。我们计划重新评估所有队列幸存者（n = 132）及其护理人员。在研究成立时，大部分患者将在TXP后9 - 13年。我们将收集3个新的数据浪潮，每个数据分别分别为1年，以解决一系列临床流行病学问题与：（a）在TXP后几年中，与抑郁症和焦虑相关的疾病的普遍性，（b）患者和护理人员在Terrangication frow takeister frof The Psychistor ta Isssipation ta Isspositigation the Trentistion to the Terriastic worders and Thecials sossistrials ye Modiress and Textrials wordials wordials（Mode）是否均具有Modiser sipors的风险（反过来，当事方的心理健康又影响了患者的持续医疗依从性和随后的身体发病率。数据收集将涉及半结构化访谈，TXP计划人员评估和病历评估。