The psychiatric diagnosis of alcohol abuse and the medical diagnosis of alcoholic related liver disease: effects on liver transplant survival.

The present study investigated whether differing diagnostic criteria for alcoholism used by mental health professionals versus hepatologists lead to different outcomes in predicting liver transplant survival as determined by the medical record and without a priori judgments. This was in contrast to past studies, particularly in the liver transplant literature, demonstrating comparable survival rates between alcoholics and non-alcoholics that have typically employed a diagnosis of Alcoholic Liver Disease (ALD), which does not capture the salient maladaptive behavioral and interpersonal features associated with DSM-IV-TR diagnoses of Alcohol Abuse (AA) and Alcohol Dependence (AD). A series of survival analyses were conducted using data culled from the psychological and medical records of 358 first-time liver transplant recipients at Barnes-Jewish Hospital in St. Louis, Missouri. The primary outcome investigated was liver graft survival following transplant surgery. Follow-up times varied from 0 days to 13 years, depending on the time of transplant and length of graft survival, with a median follow-up time of 6.2 years. Diagnoses of AA and AD predicted significantly poorer survival rates, while diagnoses of ALD did not. DSM-IV-TR alcoholism criteria appear to have greater utility for predicting survival differences beyond pathophysiologically defined alcoholic liver failure.

Psychiatric disorders: are they an absolute contraindication to living donation?

Little information has been published about the suitability of candidates for living organ donation who have a past or current psychiatric diagnosis. A retrospective review of 445 living donor kidney transplants performed at Barnes-Jewish Hospital's transplant center from 1995 to 2005 disclosed 42 donor candidates with such a history, prompting detailed psychological evaluation. Although 41 candidates (10% of the donor pool) met criteria for 1 or more psychiatric diagnoses, none were considered psychologically unfit for donation. Of these, 22 candidates underwent kidney donation without medical or surgical complications and without development of subsequent active psychological problems. Several donors maintained long-term contact up to 12 years to report good health and a high degree of satisfaction with the decision to donate. This experience suggests that for donor candidates with a psychiatric diagnosis, formal psychiatric evaluation to evaluate current mental health stability is warranted. Stable individuals, on or off therapy, can be considered fit to donate with expected short- and long-term outcome prognoses similar to those for the general population.

Evaluating and developing a multidimensional, dispositional measure of appraisal.

Although theories of stress have emphasized the critical role of the appraisal process, the use of dispositional measures of appraisal have not been readily investigated. Using a large multiethnic sample, we examined the factorial validity and dimensionality of a dispositional version of the Stress Appraisal Measure (SAM; Peacock & Wong, 1990). Both exploratory and confirmatory factor analyses resulted in a 4-factor representation of dispositional appraisal fitting better than its originally proposed 6-factor representation. This 4-factor model was invariant across gender groups. Although the 6-factor model purported to measure 3 dimensions of primary appraisal and 3 dimensions of secondary appraisal, these factors were found to be highly unstable and had questionable internal consistency. In contrast, the more parsimonious 4-factor solution identified 4 relative distinct and reliable scales of appraisal: 3 primary (Challenge, Threat, and Centrality) and 1 secondary (Resources). These findings suggest that meaningful dispositional dimensions of appraisal can be derived and incorporated into trait-state models of the stress process.

Developing and validating a stress appraisal measure for minority adolescents.

Although there are a number of measures designed to assess the cognitive appraisal of stress in adult populations, currently there are no measures that are specifically designed to assess this important construct in adolescents. To overcome this limitation, the factorial validity and dimensionality of a dispositional measure of stress appraisal was examined in the current study. Using a multiethnic adolescent sample, both exploratory and confirmatory factor analyses resulted in a three-factor representation of appraisal. The three factors included two primary appraisal dimensions (Threat and Challenge) and one secondary appraisal dimension (Resources). This three-factor model, however, is inconsistent with four- and six-factor models found previously in adult samples. Thus, these findings suggest that the cognitive appraisals made by adolescents are less complex or differentiated than those of adults. Moreover, these findings suggest that dispositional measures are relevant for adolescent samples and should be incorporated into stress and coping paradigms.

On the dimensionality of the stress-related growth scale: one, three, or seven factors?

We examined the factorial validity and dimensionality of the Stress-Related Growth Scale (SRGS; Park, Cohen, & Murch, 1996) using a large multiethnic sample (n = 1,070). Exploratory and confirmatory factor analyses suggested that a multidimensional representation of the SRGS fit better than a unidimensional representation. Specifically, we cross-validated both a 3-factor model and a 7-factor model using confirmatory factor analysis and were shown to be invariant across gender and ethnic groups. The 3-factor model was represented by global dimensions of growth that included rational/mature thinking, affective/emotional growth, and religious/spiritual growth. We replicated the 7-factor model of Armeli, Gunthert, and Cohen (2001) and it represented more specific components of growth such as Self-Understanding and Treatment of Others. However, some factors of the 7-factor model had questionable internal consistency and were strongly intercorrelated, suggesting redundancy. The findings support the notion that the factor structure of both the original 1-factor and revised 7-factor models are unstable and that the 3-factor model developed in this research has more reliable psychometric properties and structure.