Multi-disciplinary community-based group intervention for fibromyalgia: a pilot randomized controlled trial.

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances, mood disturbances, and cognitive impairment. Most individuals with fibromyalgia experience poorly managed symptoms and increased healthcare service use. Multicomponent therapies, with a focus on nonpharmacological modalities, are increasingly supported in the literature. However, given the limited resources available, implementation in smaller communities remains a challenge. This research tested a community-based multidisciplinary group intervention for individuals diagnosed with FM living in a small urban centre. The primary outcome was perceptions of quality of care and secondary outcomes included disease-related functioning, anxious and depressive symptoms, pain beliefs, and health service utilization. A pilot randomized control trial was conducted in which 60 patients diagnosed with fibromyalgia were randomized into a 10-week community-based multidisciplinary group intervention program or usual care. Treatment components included twice-weekly exercise sessions and weekly education sessions (e.g., pain education, cognitive behavioral strategies for stress, nutrition, peer support). The trial (NCT03270449) was registered September 1 2017. Statistically significant post-intervention improvements were found in the primary outcome, perceived quality of care (Cohen's d = 0.61, 0.66 for follow up care and goal setting, respectively). Secondary outcomes showing statistically significant improvements were disease-related daily functioning (Cohen's d = 0.70), depressive symptoms (Cohen's d = 0.87), and pain beliefs (Cohen's d = 0.61, 0.67, 0.82 for harm, disability and control, respectively). No adverse events were reported. Community-based multidisciplinary group interventions for fibromyalgia show promise for improving satisfaction with quality of care, disease-related functioning, and depression, and fostering more adaptive pain beliefs.

Physician perspectives on chronic pain management: barriers and the use of eHealth in the COVID-19 era.

BACKGROUND: Chronic pain is a highly prevalent and disabling condition which is often undertreated and poorly managed in the community. The emergence of COVID-19 has further complicated pain care, with an increased prevalence of chronic pain and mental health comorbidities, and burnout among physicians. While the pandemic has led to a dramatic increase in virtual health care visits, the uptake of a broader range of eHealth technologies remains unclear. The present study sought to better understand physicians' current needs and barriers in providing effective pain care within the context of COVID-19, as well as gauge current use, interest, and ongoing barriers to eHealth implementation. METHODS: A total of 100 practicing physicians in British Columbia, Canada, completed a brief online survey. RESULTS: The sample was comprised of physicians practicing in rural and urban areas (rural = 48%, urban = 42%; both = 10%), with the majority (72%) working in family practice. The most prominent perceived barriers to providing chronic pain care were a lack of interdisciplinary treatment and allied health care for patients, challenges related to opioid prescribing and management, and a lack of time to manage the complexities of chronic pain. Moreover, despite expressing considerable interest in eHealth for chronic pain management (82%), low adoption rates were observed for several technologies. Specifically, only a small percentage of the sample reported using eHealth for the collection of intake data (21%), patient-reported outcomes (14%), and remote patient monitoring (26%). The most common perceived barriers to implementation were cost, complexity, and unfamiliarity with available options. CONCLUSIONS: Findings provide insight into physicians' ongoing needs and barriers in providing effective pain management during the COVID-19 pandemic. Despite the potential for eHealth technologies to help address barriers in pain care, and strong interest from physicians, enhanced useability, education and training, and funding are likely required to achieve successful implementation of a broader range of eHealth technologies in the future.

Long-distance texting: Text messaging is linked with higher relationship satisfaction in long-distance relationships.

Due to the widespread use of smartphones, romantic couples can connect with their partners from virtually anywhere, at any time. Remote communication may be particularly important to long-distance relationships (LDRs), compared to geographically close relationships (GCRs). The goals of the current research were to examine differences between LDRs and GCRs in (1) the patterns of remote communication (video calls, voice calls, and texting), and (2) how frequency and responsiveness of remote communication are related to relationship satisfaction. Data were drawn from an online survey of emerging adults (n = 647) who were in a relationship or dating someone (36.5% were in an LDR). Participants in LDRs engaged in more frequent video calling, voice calling and texting, compared to those in GCRs. Long-distance relationship participants also perceived their partners to be more responsive during video and voice calls, compared to GCR participants. More frequent and responsive texting predicted significantly greater relationship satisfaction among participants in LDRs, but not GCRs. Meanwhile, frequency of voice calls was associated with greater relationship satisfaction in GCRs, but not in LDRs. The use of video calls was not significantly related to relationship satisfaction in either group. Overall, study findings add to a growing literature on remote communication in romantic couples and suggest a uniquely positive role of texting within LDRs. Further research is needed to examine the ways in which LDR and GCR couples can best capitalize on different forms of remote technology to maintain their relationships during periods of separation.

Fatigue, Pain, and Other Physical Symptoms of Living Liver Donors in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study.

Little is known about living liver donors' perceptions of their physical well-being following the procedure. We collected data on donor fatigue, pain, and other relevant physical outcomes as part of the prospective, multicenter Adult-to-Adult Living Donor Liver Transplantation Cohort Study consortium. A total of 271 (91%) of 297 eligible donors were interviewed at least once before donation and 3, 6, 12, and 24 months after donation using validated measures when available. Repeated measures regression models were used to identify potential predictors of worse physical outcomes. We found that donors reported more fatigue immediately after surgery that improved by 2 years after donation, but not to predonation levels. A similar pattern was seen across a number of other physical outcomes. Abdominal or back pain and interference from their pain were rated relatively low on average at all study points. However, 21% of donors did report clinically significant pain at some point during postdonation study follow-up. Across multiple outcomes, female donors, donors whose recipients died, donors with longer hospital stays after surgery, and those whose families discouraged donation were at risk for worse physical well-being outcomes. In conclusion, although not readily modifiable, we have identified risk factors that may help identify donors at risk for worse physical outcomes for targeted intervention. Liver Transplantation 00 000-000 2018 AASLD.

Predicting Daily Satisfaction with Spouse Responses Among People with Rheumatoid Arthritis.

BACKGROUND: Social support has been strongly linked to health outcomes. However, the factors associated with satisfaction with social support remain poorly understood. PURPOSE: We examined the impact of different types of support, affect, marital satisfaction, personality, and disease-related variables on day-to-day and overall satisfaction with spouse responses. METHODS: Sixty-nine married people with rheumatoid arthritis completed an initial structured interview, followed by twice-daily phone interviews for 1 week. RESULTS: Higher levels of esteem support were associated with increased satisfaction, whereas negative spouse responses were related to decreased satisfaction across the day. Greater positive affect and lower pain were associated with higher concurrent satisfaction, but the effects did not last over the day. At the between-person level, older age and lower fatigue were related to higher satisfaction. CONCLUSIONS: Several key factors related to support satisfaction were identified. Esteem support appeared to play a particularly important role and warrants attention in future research.

Predictors of HIV testing among men who have sex with men: a focus on men living outside major urban centres in Canada.

Men who have sex with men (MSM) represent almost half of new HIV infections in Canada each year. However, the vast majority of research on HIV testing among MSM has been conducted in major urban centres. The present study addressed this gap by investigating HIV testing behaviour and predictors of HIV testing among MSM living outside major urban centres, in the Interior of British Columbia. An anonymous online survey of 153 MSM assessed HIV testing behaviour and psychosocial factors that may impact HIV testing (internalized homophobia, disclosure to healthcare providers (HCPs) of same sex attraction, and gay community involvement). Almost one-quarter (24%) had never been tested and over one-third (35%) had not disclosed same sex attraction to HCPs. Internalized homophobia was associated with a lower likelihood of HIV testing, and this relationship was partially explained by the fact that those high in internalized homophobia were less likely to disclose same sex attraction to their HCPs. Neither formal nor informal involvement in the gay community was related to HIV testing, and both types of involvement were relatively low in our sample. Further research is needed to better understand the distinctive health issues facing MSM living outside major urban centres.

Acute and chronic postsurgical pain after living liver donation: Incidence and predictors.

Despite its prominence as a concern among potential surgical candidates, there is little information in the literature regarding the short- and long-term pain experience after living liver donation. We undertook a prospective study to examine (1) the nature and incidence of acute and chronic pain after living donor hepatectomy and (2) the factors associated with an increased or decreased risk of adverse pain outcomes. Before donation, a comprehensive assessment of potential predictors of acute and chronic pain outcomes was conducted; this included donors' pain expectations, psychosocial factors, medical histories, and demographic factors. Detailed data regarding pain outcomes were collected postoperatively (days 1 and 2) and again during 6- and 12-month follow-up telephone interviews. Sixty-five adults (32 females and 33 males) scheduled for donor hepatectomy participated. Substantial proportions of the donors reported a moderate-to-severe level of pain intensity (≥4 on a 0-10 scale) at rest and after movement on day 1 (42% and 74%, respectively) and day 2 (33% and 32%, respectively). Persistent postsurgical pain was reported by 31% of the donors at the 6-month follow-up and by 27% of the donors at the 12-month follow-up. Generally, this pain was mild, and pain-related life interference was minimal. Female sex, a younger age, and several predonation measures of pain-related anxiety were associated with a significantly greater risk of developing persistent postsurgical pain. In conclusion, this study has identified a subset of patients who experience persistent pain after living liver donation. Additional prospective research using larger samples of liver donors is needed to replicate this work, to obtain a more detailed account of the acute and long-term pain experience, and to determine whether targeted interventions can minimize the frequency and severity of chronic pain.

Does a diagnosis of depression influence observer ratings of pain severity? The mediating role of causal attributions of pain and pain genuineness.

Researchers have been increasingly investigating observer and patient characteristics that may influence the assessment of pain in others. While rates of psychiatric conditions are high in chronic pain populations, surprisingly little attention has been given to if (and why) a comorbid psychiatric diagnosis may influence the estimation of pain in others. Using an experimental vignette paradigm, the current study examined whether a diagnostic label of major depressive disorder (MDD) would impact observer pain estimates of a woman with chronic pain, and whether causal attributions of pain and pain genuineness might help explain these effects. Participants (n = 188) were given a vignette describing a female patient with chronic pain (who either had MDD or no mental health concerns), viewed a brief video clip of the patient, and then were asked to provide a variety of ratings about the woman's pain. Results of a serial multiple mediation analysis revealed that participants in the MDD condition made greater psychological attributions for the woman's pain, which was associated with lower perceptions of pain genuineness, which was then associated with lower estimates of pain intensity. These findings suggest that a diagnosis of depression may indirectly influence observer estimates of another person's pain by heightening psychological attributions of pain, and making their pain seem less genuine. Further research is needed to elucidate the complex processes underlying pain estimation, including patient and observer characteristics, biases, and heuristics, in order to improve quality of care for those living with persistent pain.'

Understanding the link between pain invalidation and depressive symptoms: The role of shame and social support in people with chronic pain.

Pain invalidation (e.g., having pain discounted) is a risk factor for depression among people with chronic pain, but the mechanisms remain unclear. Shame is a common, yet understudied, aspect of the pain experience. This study investigated whether pain-related shame helps explain the relationship between pain discounting and heightened depressive symptoms. The secondary aim was to examine whether social support can protect against the harmful effects of discounting. Patients with chronic pain (N = 305) were recruited from outpatient pain clinics. Participants completed an online cross-sectional survey and data were analyzed using moderated mediation analysis. Greater discounting was associated with greater depressive symptoms, and pain-related shame significantly mediated this relationship. Perceived social support attenuated the relationship between discounting and depressive symptoms. Greater attention towards pain-related shame as a treatment target is needed. Individual- and system-level interventions are required to address pain invalidation and bolster support for this population.

The Naturalistic Cannabis Administration Protocol (NCAP): A Proof-of-Concept Study.

Lab-based studies examining the effects of cannabis administration on human behavior compromise ecological validity due to the influence of set and setting. Contextual factors of clinical settings have long been recognized as producing measurable changes in physiology, emotionality, and cognition. Among people who use drugs, these settings may be associated with higher levels of perceived stigma and stereotype threat which may meaningfully confound the effects of cannabis on outcomes of interest. Recent liberalization of cannabis regulation may allow novel and more ecologically valid approaches to assessing the acute effects of cannabis. The Naturalistic Cannabis Administration Protocol (NCAP) is a novel paradigm for the study of acute cannabis effects in an ecologically valid manner. Two independent studies demonstrated the safety and feasibility of the NCAP. Participants (N= 79; Mage = 25.44, SD = 5.67) self-administered the cannabis of their choice in their home and then (Study 1; n= 47) engaged in a leisure activity or (Study 2; n= 32) underwent cognitive assessment remotely via videoconference following cannabis administration. The NCAP was well tolerated across samples with no reported adverse events. These findings provide a rationale for the adoption of the NCAP to reduce research barriers and develop our research capabilities to fit the landscape of cannabis use today.

A genetic predisposition to produce low levels of IL-10 is related to depressive symptoms: a pilot study of patients with end stage renal disease.

OBJECTIVE: Heightened levels of inflammation may be associated with an increased risk of depression, particularly among those with inflammatory medical conditions. Although elevated rates of both systemic inflammation and depression have been documented among patients with end stage renal disease (ESRD), the link between these factors has received little empirical evaluation. The goal of this pilot study was to investigate the association between cytokine gene polymorphisms (that are known to influence pro- and anti-inflammatory cytokine production) and depressive symptoms among patients with ESRD. METHODS: Ninety-three patients with ESRD completed the Beck Depression Inventory-II and the disease-related symptom subscale of the Kidney Disease Quality of Life short form. Patients were genotyped for eight single nucleotide polymorphisms in genes coding for pro-inflammatory (TNF-α, IL-6, IFN-γ) and anti-inflammatory (IL-10, TGF-ß1) cytokines. RESULTS: Regression analyses indicated that patients with the A/A genotype for the IL-10 -1082 polymorphism (lower IL-10 producers) reported significantly greater depressive symptoms than G allele carriers (higher IL-10 producers; b = 0.22, P = 0.011), even after controlling for relevant covariates. CONCLUSION: These findings provide some support for cytokine theories of depression in the medically ill, and specifically for the protective role of anti-inflammatory processes. Further research is needed to confirm these preliminary results and to explore the possibility of identifying subtypes of depressed patients based on inflammatory profiles, and those who may benefit from anti-inflammatory therapies.

The Multidimensional Lexicon of Emojis: A New Tool to Assess the Emotional Content of Emojis.

Emerging studies suggest that emojis can make important contributions to the emotional content and meaning of digital messages. Yet researchers currently lack adequate tools to incorporate emojis into their analyses. To address this gap, we used over 3 million Twitter posts from a period of 17 months and emotion ratings provided by 2,230 human raters to develop and validate the Multidimensional Lexicon of Emojis (MLE). This new lexicon consists of 359 common emojis rated on ten emotion and sentiment dimensions. The MLE is an open-access tool that holds promise for those interested in conducting a comprehensive analysis of the emotional content of digital communication that incorporates emojis and goes beyond the dimensions of negativity and positivity.

Do pain management apps use evidence-based psychological components? A systematic review of app content and quality.

Background: With hundreds of pain management apps on the Canadian marketplace, it can be challenging for patients and clinicians to select effective and evidence-based mobile health (mHealth) apps that address pain from a biopsychosocial perspective. Aims: The aim of this study is to identify pain management apps within the Canadian app marketplaces to aid clinicians in recommending apps. Methods: The iOS and Android marketplaces were systematically searched to identify pain management apps that included at least one core component of cognitive behavioral therapy (CBT) or mindfulness- and acceptance-based therapies. Selected apps were assessed using a researcher developed psychological components checklist, and the Mobile App Rating Scale (MARS). These two measures provided a robust assessment of the apps' technical abilities and psychological principles being implemented. Results: Five hundred eight pain management apps were identified, yet only 12 included a psychological component and were available for evaluation. On average, apps contained 8.10 out of 18 psychological components (SD = 2.77) with a MARS quality rating of 4.02 out of 5 (SD = 0.32). The most common psychological components were grounded in CBT, including psychoeducation, sleep hygiene, behavioral activation, coping skills training, and social support. Among the least commonly included components were goal setting, values, and culture/diversity. Two-thirds of the apps involved health care practitioners in their development, but independent scientific review of apps was scarce. Conclusion: The highest scoring apps (Curable, Pathways, Vivify) are highlighted for health care practitioners who may wish to recommend mHealth technologies to their patients for pain management. Future directions for research and app development are discussed.

Contexte: Le fait qu'il existe des centaines d'applications de prise en charge de la douleur sur le marché canadien peut faire en sorte qu'il soit difficile pour les patients et les cliniciens de choisir une application de santé mobile (mHealth) efficace et fondée sur des données probantes, qui aborde la douleur d'un point de vue biopsychosocial.But: Le but de cette étude est de répertorier les applications de prise en charge de la douleur disponibles sur les marchés des applications canadiens afin d'aider les cliniciens à en recommander certaines.Méthodes: Les marchés iOS et Android ont été systématiquement consultés pour répertorier les applications de prise en charge de la douleur qui comprennent au moins une composante de base de la thérapie cognitivo-comportementale (TCC) ou des thérapies fondées sur la pleine conscience et l'acceptation. Les applications sélectionnées ont été évaluées à l'aide d'une liste de vérification des composantes psychologiques élaborée par un chercheur et le Mobile App Rating Scale (MARS). Ces deux mesures ont fourni une évaluation robuste des capacités techniques et des principes psychologiques mis en œuvre.Résultats: Cinq cent huit applications de prise en charge de la douleur ont été répertoriées, mais seulement 12 d'entre elles comprenaient une composante psychologique et étaient disponibles pour l'évaluation. En moyenne, les applications contenaient 8,10 des 18 composantes psychologiques (ÉT = 2,77) et obtenaient un score de qualité MARS de 4,02 sur 5 (ÉT = 0,32. Les composantes psychologiques les plus courantes étaient ancrées dans la TCC, y compris la psychoéducation, l'hygiéne du sommeil, l'activation comportementale, la formation aux compétences d'adaptation et le soutien social. Les composantes les moins souvent incluses étaient l'établissement d'objectifs, les valeurs et la culture/diversité. Deux-tiers des applications avaient impliqué des praticiens de la santé dans leur développement, mais peu d'entre elles avaient été soumises à un examen scientifique indépendant.Conclusion: Les applications ayant obtenu les scores les plus élevés (Curable, Pathways, Vivify) sont mises en évidence à l'intention des praticiens des soins de santé qui peuvent souhaiter recommander des technologies de santé mobile à leurs patients pour la prise en charge de la douleur. Les orientations futures pour la recherche et le développement d'applications sont abordées.

What twitter can tell us about user experiences of crisis text lines: A qualitative study.

Mental health problems are the leading cause of disability worldwide. Despite the prevalence and cost of mental illness, there are insufficient health services to meet this demand. Crisis hotlines have a number of advantages for addressing mental health challenges and reducing barriers to support. Mental health crisis services have recently expanded beyond telephone hotlines to include other communication modalities such as chat and text messaging services, largely in response to the increased use of mobile phones and text messaging for social communication. Despite the high uptake of crisis text line services (CTLs) and rising mental health problems worldwide, CTLs remain understudied. The current study aimed to address an urgent need to evaluate user experiences with text-based crisis services. This study explored user experiences of CTLs by accessing users' publicly available Twitter posts that describe personal use and experience with CTLs. Data were qualitatively analyzed using thematic analysis. Six main themes were identified from 776 tweets: (1) approval of CTLs, (2) helpful counselling, (3) invalidating or unhelpful counselling, (4) problems with how the service is delivered, (5) features of the service that facilitate accessibility, and (6) indication that the service suits multiple needs. Overall, results provide evidence for the value of text-based crisis support, as many users reported positive experiences of effective counselling that provided helpful coping skills, de-escalation, and reduction of harm. Results also identified areas for improvement, particularly ensuring more timely service delivery and effective communication of empathy. Text-based services may require targeted training to apply methods that effectively convey empathy in this medium. Moving forward, CTL services will require systematic attention in the clinical research literature to ensure their continued success and popularity among users.

Trajectories and Correlates of Anger During the Perinatal Period.

OBJECTIVES: To investigate trajectories of anger during pregnancy and the early postpartum period; to identify baseline psychosocial predictors of anger trajectory group membership; and to examine correlates of anger trajectory group membership, including symptoms of depression, anxiety, insomnia, and social support, in the postpartum period. DESIGN: Longitudinal descriptive design. SETTING: We recruited participants from a maternity clinic in Calgary, Alberta, Canada. PARTICIPANTS: The sample included a convenience sample of 143 pregnant women who had basic fluency in English, were older than 17 years of age, and were less than 19 weeks gestation with a single fetus at the time of recruitment. METHODS: Participants completed online questionnaires at four time points: early, mid-, and late pregnancy and 2 months after birth. We used group-based semiparametric mixture modeling to estimate patterns of anger. We used multinomial logistic regression to explore associations between baseline predictors and trajectory membership. RESULTS: We identified four distinct trajectories of anger during pregnancy through 2 months after birth: minimal-stable anger (55%), mild-stable anger (24%), moderate-stable anger (14%), and high-decreasing anger (7%). Membership in the moderate-stable group was associated with greater baseline symptoms of depression, anxiety, and insomnia severity scores compared to the minimal-stable anger group. Moderate-stable trajectory group membership was also associated with greater symptoms of anxiety, depression, and insomnia at 2 months after birth. CONCLUSION: Higher levels of anger were associated with worse mental health in pregnancy and after childbirth in our participants. Women should be made aware of anger as a possible mood disturbance by clinicians, and researchers should investigate the consequences of anger during the perinatal period.

Epidural analgesia provides better pain management after live liver donation: a retrospective study.

Despite the increase in surgical volumes of live liver donation, there has been very little documentation of the postoperative pain experience. The primary aim of this study was to examine the difference in acute postoperative pain intensity and adverse effects between patients who received intravenous patient-controlled analgesia (IV PCA) or patient-controlled epidural analgesia (PCEA) for pain control after live liver donation surgery. A retrospective chart review was performed of 226 consecutive patients who underwent right living donor hepatic surgery at the Toronto General Hospital, Toronto, Canada. Patients who received as their primary postoperative analgesic modality IV PCA (n = 158) were compared to patients who received PCEA (n = 68). Demographic profiles for the 2 groups were similar with respect to age, sex, and body mass index at the time of surgery. For the first 3 postoperative days, pain intensity was significantly lower in patients who received epidural analgesia (P < 0.01). Clinically significant moderate pain (defined as a Numeric Rating Scale pain score >4) was reported more frequently in the IV PCA group (P < 0.05) along with increased sedation (P < 0.05). Pruritus was reported more frequently in the PCEA group of patients compared to the IV PCA group (P < 0.05). Significant between-group differences were not found for the incidence of postoperative vomiting, the time at which patients began fluid intake, the time to initial ambulation, or the length of hospital stay. In conclusion, epidural analgesia provides better postoperative pain relief, less sedation, but more pruritus than IV PCA after live liver donation.

Pain after heart transplantation: prevalence and implications for quality of life.

BACKGROUND: Because of increasing survival rates among transplant recipients, there is now growing attention on evaluating and enhancing patient quality of life (QOL) during these extended years of survival. OBJECTIVE: The authors investigated the prevalence of pain among heart-transplant recipients, and the extent to which pain may affect QOL posttransplant. METHOD: Ninety-two heart recipients completed a questionnaire, including measures of QOL and demographics. RESULTS: Almost half of all patients (46%) reported at least mild pain, and 21% reported moderate to very severe pain. Across all Health Survey (SF-36) domains, patients with at least mild pain reported worse QOL than the general population. Those with no or very mild pain reported social functioning and mental health comparable to population norms. Patients with at least mild pain were also less likely to be employed. CONCLUSION: Given the effects of pain on QOL in transplant patients, increased attention toward more effective clinical assessment and treatment of pain is warranted.

Financial, vocational, and interpersonal impact of living liver donation.

The ability to inform prospective donors of the psychosocial risks of living liver donation is currently limited by the scant empirical literature. The present study was designed to examine donor perceptions of the impact of donation on financial, vocational, and interpersonal life domains and identify demographic and clinical factors related to longer recovery times and greater life interference. A total of 143 donors completed a retrospective questionnaire that included a standardized measure of life interference [Illness Intrusiveness Rating Scale (IIRS)] and additional questions regarding the perceived impact of donation. Donor IIRS scores suggested that donors experience a relatively low level of life interference due to donation [1.60 +/- 0.72, with a possible range of 1 ("not very much" interference) to 7 ("very much" interference)]. However, approximately 1 in 5 donors reported that donating was a significant financial burden. Logistic regression analysis revealed that donors with a psychiatric diagnosis at or prior to donation took longer to return to their self-reported predonation level of functioning (odds ratio = 3.78, P = 0.016). Medical complications were unrelated to self-reported recovery time. Multiple regression analysis revealed 4 independent predictors of greater life interference: less time since donation (b = 0.11, P < 0.001), income lower than CAD$100,000 (b = 0.28, P = 0.038), predonation concerns about the donation process (b = 0.24, P = 0.008), and the perception that the recipient is not caring for the new liver (b = 0.12, P = 0.031). In conclusion, life interference due to living liver donation appears to be relatively low. Donors should be made aware of risk factors for greater life disruptions post-surgery and of the potential financial burden of donation.

Prevalence and Predictors of Patient-Reported Long-term Mental and Physical Health After Donation in the Adult-to-Adult Living-Donor Liver Transplantation Cohort Study.

BACKGROUND: Prospective and longitudinal studies have examined liver donors' medical outcomes beyond the first 1 to 2 years postdonation. There is no analogous longitudinal evidence on long-term psychosocial outcomes, including patient-reported clinically significant mental health problems and perceptions of physical well-being. We examined prevalence, descriptive characteristics, and predictors of diagnosable mental health conditions and self-reported physical health problems, including fatigue and pain, in the long-term years after liver donation. METHODS: Donors from 9 centers who initially completed telephone interviews at 3 to 10 years postdonation (mean, 5.8 years; SD, 1.9) were reinterviewed annually for 2 years using validated measures. Outcomes were examined descriptively. Repeated-measures regression analyses evaluated potential predictors and correlates of outcomes. RESULTS: Of 517 donors initially interviewed (66% of those eligible), 424 (82%) were reassessed at least once. Prevalence rates of major depression and clinically significant pain were similar to general population norms; average fatigue levels were better than norms. All prevalence rates showed little temporal change. Anxiety and alcohol use disorder rates exceeded normative rates at 1 or more assessments. Longer postdonation hospitalization, female sex, higher body mass index, concerns about donation-related health effects, and burdensome donation-related financial costs were associated with increased risk for most outcomes (P's < 0.05). Men were at higher risk for alcohol use disorder (P < 0.001). CONCLUSIONS: Anxiety and alcohol use disorders were more common than would be expected; they may warrant increased research attention and clinical surveillance. Surveillance for long-term problems in the areas assessed may be optimized by targeting donors at higher risk based on identified predictors and correlates.