RESUMO
Rather little is known about how psychosocial evaluations for living kidney donation (LKD) are performed. We aimed to explore whether Swiss transplant centers (STCs) vary regarding the rate of living kidney donors refused for psychosocial reasons, the psychosocial evaluation process, and the characteristics of the donors. Methods: We investigated 310 consecutive candidates for LKD in 4 of 6 existing STC during mandatory psychosocial evaluations. We registered (i) sociodemographic data, (ii) the type of the decision-making process regarding LKD (ie, snap decision, postponed, deliberate, other), (iii) the evaluator's perception of the donor's emotional bonding and his/her conflicts with the recipient, (iv) the donor's prognosis from a psychosocial perspective, (v) time taken for the psychosocial evaluation, and (vi) its result (eligible, eligible with additional requirements, not eligible). Results: Centers had comparable proportions of noneligible donors (2.9%-6.0%) but differed significantly in the percentage of donors accepted with additional requirements (3.4%-66%, P < 0.001). Significant differences emerged between centers regarding the time needed for evaluation (75-160 min [interquartile range (IQR) 75-180 min] per single exploration, P < 0.001), the perception of the donor's emotional bonding (visual analogue scale [VAS] 8-9 [IQR 6-10], P < 0.001), his/her conflicts with the recipient (VAS 1.5-2 [IQR 0-3], P = 0.006), the donor's psychosocial prognosis (VAS 8-9 [IQR 7-10], P < 0.001), and the type of decision concerning LKD (59%-82% with snap decision "yes," P = 0.008). However, despite differences in the psychosocial evaluation process, the rates of patients accepted for transplantation (eligible and eligible with additional requirements versus noneligible) were comparable across STC (P = 0.72). Conclusions: Our results emphasize that it is more important to establish clear guidelines to identify potential psychosocial risks than to stringently standardize the procedure for psychosocial evaluation of living kidney donors.
RESUMO
OBJECTIVES: The objectives of the study were to examine (1) whether patients with social phobia report higher symptom load at the beginning and at the end of treatment and 1 year after treatment; and (2) whether the presence of social phobia is a factor that influences the course of treatment. METHODS: 613 patients from a university hospital for psychosomatic medicine filled out questionnaires assessing symptom load (SCL 90-R, KOPS), physical symptoms, psychological and social impairment (KOPS), and depression (BDI). Social phobia was diagnosed based on a standardized diagnostic interview. RESULTS: 25%of the patients suffered from social phobia. They had significantly more concurrent mental disorders (4.18 vs. 2.41) and a higher symptom load than patients suffering from other mental disorders. They reported more physical complaints and depression and felt more impaired psychologically as well as socially. Even though both groups of patients profited from the treatment, compared to other patients, social phobia patients still had higher symptom load, impairment, and depression scores at the end of treatment and even at the follow-up 1 year after treatment. DISCUSSION: Social phobia is a severe disorder in which concurrent disorders frequently cause a high level of distress and impairment. These patients may benefit more from longer courses of treatment and/or disorder-specific treatment elements. Diagnostic and therapy approaches tailored to the generalized type of social anxiety are discussed.