COVID-19-Related Fear and Health-Related Safety Behavior in Oncological Patients.

OBJECTIVE: This study aimed to assess cancer patients' psychological burden during the COVID-19 pandemic by investigating distress (distress-thermometer), health status (EQ-5D-3L), general anxiety (GAD-7), COVID-19-related fear and associated behavioral changes and comparing these to matched healthy controls, using propensity score matching (PSM). METHODS: During the first days of the COVID-19 pandemic in Germany, March 16 to 30, 2020, 150 actually treated cancer patients and 150 matched healthy controls participated in this study. Participants completed an anonymous online survey assessing health status, distress, general anxiety, COVID-19-related fear and behavioral changes (i.e., adherent safety behavior and dysfunctional safety behavior). RESULTS: Cancer patients showed no elevated level of distress, U = 10,657.5, p = 0.428, general anxiety U = 10,015.5, p = 0.099, or COVID-19-related fear compared to healthy controls, U = 10,948, p = 0.680. Both groups showed elevated COVID-19-related fear. Cancer patients reported more adherent safety behavior, such as washing hands more often or avoiding public places, U = 8,285, p < 0.001, d = 0.468. They also reported more dysfunctional safety behavior such as buying larger quantities of basic food, compared to healthy controls U = 9,599, p = 0.029, d = 0.256. Adherent safety behavior could be significantly explained by cancer diagnosis, increased COVID-19-related fear and subjective level of information about COVID-19, R 2 = 0.215, F(3) = 27.026, p < 0.001. CONCLUSION: This suggests that cancer patients are more likely to utilize adherent safety behavior. Cancer patients reported comparable levels of distress and anxiety compared to healthy controls. Still, the COVID-19 pandemic is associated with elevated COVID-19-related fear. Therefore, specific interventions are needed to prevent anxiety and improve mental health during the COVID-19 pandemic.

Web-based MINDfulness and Skills-based distress reduction in cancer (MINDS): study protocol for a multicentre observational healthcare study.

INTRODUCTION: Although a high percentage of patients with cancer experience severe psychological distress, few of them receive psycho-oncological care, largely due to barriers on the side of patients and healthcare providers that pose great challenges to delivering such care. In response, low-threshold, self-guided eHealth interventions can enable patients with cancer to deal independently and effectively with disease-related challenges and distress. Mindfulness and Skills-Based Distress Reduction in Oncology Training, nicknamed Make It Training, is one such innovative, self-guided eHealth intervention. In our study, we propose to assess different characteristics of such patients in order to define target populations for Make It Training, evaluate the intervention in terms of its usability, feasibility and sustainability and gather longitudinal data concerning the intervention's efficacy. METHODS AND ANALYSIS: Self-guided and web-based Make It Training consists of eight 30 min modules involving the use of techniques of mindfulness therapy, cognitive-behavioural therapy and acceptance and commitment therapy to be completed in a 4-month period. In our observational study, adult patients with cancer who possess adequate German language skills and provide their informed consent will be recruited at Essen, Erlangen and Tübingen University Hospitals at outpatient oncological institutions and via online channels. Patients will undergo a baseline online assessment (T0), an assessment directly after completing the intervention (T1) and assessments 3 and 6 months later (T2 and T3, respectively). With the results of those assessments, we will perform descriptive analyses of their sociodemographic and medical data, compare means and conduct regression analyses. ETHICS AND DISSEMINATION: The Ethics Committees of the University Hospitals Essen, Erlangen and Tübingen have approved the study (19-8643-BO, 27_19 B, 293/2018BO1). Results will be published in peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER: DRKS00017119.

A Systematic Review of the Effect of Neurofeedback in Cancer Patients.

INTRODUCTION: Neurofeedback (NF) or electroencephalogram (EEG)-Biofeedback is a drug-free form of brain training to directly alter the underlying neural mechanisms of cognition and behavior. It is a technique that measures a subject's EEG signal, processes it in real time, with the goal to enable a behavioral modification by modulating brain activity. The most common application of the NF technology is in epilepsies, migraine, attention-deficit/hyperactivity disorder, autism spectrum disorder, affective disorders, and psychotic disorders. Few studies have investigated the use of NF in context of psychosomatic illnesses. Little is known about the use in cancer patients or postcancer survivors despite the high number of this patient group. OBJECTIVES: We here provide a systematic review of the use and effect of NF on symptoms and burden in cancer patients and long-term cancer survivors. METHODS: In conducting this systematic review, we followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Statement. RESULTS: Our search resulted in only 3 experimental studies, 1 observational study, and 2 case reports. Given the heterogeneity of the intervention systems and protocols, no meta-analysis was conducted. CONCLUSION: Altogether, there is initial evidence that NF is a complementary, drug-free, and noninvasive therapy that has the potential to ameliorate symptoms in this patient group, such as pain, fatigue, depression, and sleep. Further studies are highly needed.

Knowledge and Self-Efficacy Assessment of Residents and Fellows Following Palliative Care Unit Rotation: A Pilot Study.

BACKGROUND: In Germany, some units of specialized palliative care (SPC) offer a 6- to 12-month rotation for resident physicians (RPs) and fellows from different specialties. OBJECTIVE: This pilot study aimed to evaluate feasibility of assessing palliative care knowledge (PCK) and palliative care self-efficacy (PCSE) using a paper-based questionnaire. METHODS: Palliative care knowledge and PCSE were assessed by introducing a score, followed by a descriptive analysis (determination of frequency, mean, median, and range) using nonparametric tests (χ2 test, Mann-Whitney U test). RESULTS: We assessed 17 RPs following SPC rotation and 16 board-certified specialists (BCSs) who had no experience in SPC from 3 German comprehensive cancer centers. Resident physicians were predominantly enrolled in residency programs of hematology and oncology (n = 6), anesthesiology (n = 6), and psychosomatic medicine (n = 3). Resident physicians rotated between year 1 and 8 of residency. Fifteen RPs (88%) had elected this rotation and 72% preferred 12-month duration. The total PCK score of PCK was 27 (RPs) and 24 (BCSs; P = .002). Mean PCSE scores were 46 (RPs) and 39 (BCSs; P = .016). Of 71% of RPs, only 27% of BCSs knew how support of hospice service was initiated ( P = .004). Participants rated the items as comprehensible (n = 24; 73%), relevant (n = 25; 76%) and the questionnaire as adequately long (n = 23; 70%). CONCLUSION: An improved PCK and PCSE were observed in physicians who rotated through an SPC unit; this resulted in an increased tangibility of local palliative care and hospice services. The questionnaire was comprehensible, relevant in terms of content, and adequate in length for a prospective multicenter survey.

Predictors of outpatients' request for palliative care service at a medical oncology clinic of a German comprehensive cancer center.

PURPOSE: Early integration of palliative care (PC) is recommended. The determination of predictors for patients' request for PC may guide implementation in clinical practice. Toward this end, we analyzed the symptom burden and distress of cancer patients in outpatient care and examined their need and request for PC. METHODS: Between October 2013 and March 2016, 705 patients receiving outpatient cancer treatment took part in the survey. We used the new MInimal DOcumentation System to detect symptom clusters. Additionally, patients' request for palliative and psychosocial support was assessed. Groups of patients with PC request were compared to patients without PC request regarding their symptom clusters. Logistic regression analysis was applied to discover significant predictors for the requested inclusion of PC. RESULTS: A total of 159 patients (25.5%) requested additional support by PC. Moderate and severe tiredness (40.3%), weakness (37.9%), pain (25.0%), loss of appetite (22.3%), and dyspnea (19.1%) were the most frequent symptoms. The group of patients requesting PC differed significantly in terms of pain, nausea, dyspnea, constipation, weakness, loss of appetite, tiredness, depression, and anxiety from patients without request for PC (p < .01). The perceived need for PC was identified by the significant predictors "depression," "anxiety," and "weakness" with an explained variance of 22%. CONCLUSION: Combining a standardized screening questionnaire and the assessment of patients' request for PC allows systematic monitoring for patients' need for PC in a large Medical Oncology clinic. Depression, anxiety, and weakness are predictors of requesting PC service by patients receiving outpatient cancer treatment.

Posttraumatic Stress Disorder, Quality of Life, and the Subjective Experience in Liver Transplant Recipients.

OBJECTIVE: A high prevalence of posttraumatic stress disorder (PTSD) symptoms among transplant recipients has been associated with a low adherence to treatment and poor survival. It is crucial to detect and prevent the development of posttraumatic stress in transplant settings. METHODS: We examined the prevalence of posttraumatic stress symptoms in 3 liver transplant recipients by means of the Essen Trauma Inventory (ETI), a self-report questionnaire. The Short Form-36 was used to assess the perceived health-related quality of life. Patients were asked to indicate the most traumatic events within the context of the liver transplantation procedure. RESULTS: Five patients (4.9%) fulfilled the criteria for PTSD related to liver disease or transplantation (ETI score greater than 27). In these patients, diagnosis was confirmed by a structured clinical interview. Fourteen (13.6%) patients had a partial PTSD with the ETI score less than 27 and greater than 16. Posttraumatic stress symptoms were significantly associated with perceived poor physical and mental health-related quality of life. Patients reported that the physicians' disclosure of diagnosis was experienced as traumatic, followed by treatment in an intensive care unit and the liver transplantation itself. CONCLUSIONS: The ETI resulted in prevalence rates for PTSD comparable to previous studies in liver transplantation settings. Medical professionals requested additional training in how to deliver severe diagnoses to patients.

Standardized Evaluation of Candidates Before Liver Transplantation With the Transplant Evaluation Rating Scale.

BACKGROUND: The Transplant Evaluation Rating Scale (TERS) was developed to provide a standardized evaluation of the psychosocial functioning of patients, before transplantation. Yet, the first 2 items of the TERS are based on psychiatric diagnoses referring to Diagnostic and Statistical Manual (DSM)-III-R, which leads to a duplication of disorder-specific and symptom-specific contents, that makes it complex to rate. Moreover, the TERS has not been updated to DSM revisions and DSM is not used for the official clinical routine documentation in several European countries. OBJECTIVE: The objective of this study was, therefore, to investigate the psychometric properties of a diagnoses-corrected version of the TERS (items 1 and 2 omitted). METHODS: In 85 patients awaiting liver transplantation, the discrimination capacities, predictive value, convergent validity, and interrater reliability of the original version (TERS10) and the diagnoses-corrected version (TERS8) were analyzed. RESULTS: In both versions, patients with psychiatric diagnoses (69.4%) exhibited significantly higher TERS mean values than patients without psychiatric disorders. This also held for patients who were temporarily not found eligible for transplantation in the psychosocial evaluation (25.9%) compared with patients who were eligible for listing for transplantation. Furthermore, the area under the curve was >0.90 for both versions and a cutoff of 32.25 is suggested for TERS8 (sensitivity of 90.9% and specificity of 87.3%). CONCLUSIONS: Our results substantiate good psychometric properties of the revised (diagnoses corrected) TERS, which is of great benefit for standardized psychosocial evaluation before liver transplantation. Further, validation of TERS8 and its cutoff in other samples of (liver) transplantation patients is needed.

Integration of Clinical Examination, Self-Report, and Hair Ethyl Glucuronide Analysis for Evaluation of Patients With Alcoholic Liver Disease Prior to Liver Transplantation.

CONTEXT: A large proportion of liver transplants (LTXs) are performed due to alcoholic liver disease (ALD) in the final stage of organ insufficiency. In order to list patients for LTX, transplant centers commonly require 6 months abstinence from alcohol. However, significant differences have been reported between alcohol intake as indicated by self-report and biochemical markers of alcohol. OBJECTIVE: In the present study, the usefulness of ethyl glucuronide analysis in hair (hETG) was examined during the evaluation procedure before listing patients with ALD for an LTX. DESIGN: Cross-sectional survey. SETTING: Psychosomatic evaluation. PATIENTS: Seventy patients with ALD prior to listing for an LTX. INTERVENTIONS: According to clinical assessment before listing patients with ALD (n = 233) for an LTX, hETG analysis was only performed in the patients who were assumed to deny or underreport their alcohol consumption (n = 70). MAIN OUTCOME MEASURES: The analysis of hETG by liquid chromatography-mass spectrometry, clinical interview. RESULTS: By hETG analyses, 27 (38.6%) of the 70 patients tested positive for ongoing alcohol consumption. CONCLUSIONS: Selective use of hETG based on the clinical interview rather than widespread screening is a possible way to detect excessive alcohol consumption in patients with ALD in the transplant setting. The primary evaluation of a patient's situation in its entirety should remain the superordinate standard procedure. An interdisciplinary approach to transplant candidates with an ALD is asked for.

Resilience and quality of life in 161 living kidney donors before nephrectomy and in the aftermath of donation: a naturalistic single center study.

BACKGROUND: Due to the shortage of cadaveric organs, living kidney donation has begun to serve as the most crucial organ pool. Transplant centers have a legitimate interest in expanding the pool of donors. A psychosocial evaluation is established in transplantation centers to prevent donors from possible emotional harm in the aftermath of donation. We explored if the resilience questionnaire is an appropriate measure of the mental stability. To standardize procedures of psychosocial evaluation and to optimize donor recruitment, we present our evaluation protocol and analyze the causes of exclusion from donation. METHOD: In a naturalistic design, we compared resilience and quality of life in eligible and excluded donors at the time point of donation. Potential living kidney donors (N = 161) participated in the obligatory psychosomatic evaluation. Quality of life (World Health Organization Quality of Life, WHOQOL-Bref) and resilience (Resilience Scale, RS-12) were measured. Three months after nephrectomy donors quality of life was screened in a follow-up. RESULTS: In the evaluation interview donors were classified as eligible (n = 142) or excluded (n = 12). Nonrelated donors (n = 3) were excluded from donation significantly more often (p < .011). Eligible donors (M = 78.42, SD = 10.19) had higher values for resilience than excluded donors (M = 72.7, SD = 8.18, p < .04), who showed values comparable to the norm. In all domains of quality of life, eligible donors had significantly higher values than healthy normals (p < .001). After donation health-related quality of life decreased, but was comparable to the norm. A regression analysis showed that resilience was a significant predictor for all dimensions of quality of life before donation (R(2) = 10.2-24.6 %). Post-donation quality of life was significantly correlated with pre-donation resilience scores (p < .05). CONCLUSIONS: The resilience score predicts high mental quality of life before and after donation. Therefor it can be implemented as a self-rating instrument to further objectify donor's mental stability. Despite the stressful life event of donation, donor candidates presented high resilience and high levels of quality of life. Therefor our findings support health care providers` intentions to improve living donation. In the group of excluded donors nonrelated persons were overrepresented. Guidelines for the admission of nonrelated donors are currently unclear and need to be optimized.

Anxiety, posttraumatic stress, and fear of cancer progression in patients with melanoma in cancer aftercare.

UNLABELLED: Several studies have described mental distress and anxiety in patients with melanoma. The findings of these studies varied from patients with a quality of life similar to the general population and those with increased mental distress. In the present study, we investigated anxiety, posttraumatic stress, and fear of cancer progression to gain a detailed picture of the burdens of these patients. PATIENTS AND METHODS: 70 patients with malignant melanoma who attended cancer aftercare were surveyed using the psychometric instruments Hospital Anxiety and Depression Scale (HADS), Posttraumatic Symptom Scale (PTSS-10), and Fear of Progression Questionnaire (FoP-Q). The questionnaires were evaluated and an analysis of the single items carried out. RESULTS: The scores for the three anxiety parameters were low, but 7% of the patients presented an increased HADS score, and 17% an increased PTSS-10 value. An analysis of the items showed that patients feared physical disabilities more than mental distress or lack of social support. CONCLUSION: Most of the patients perceived themselves as stable, and relied on the assistance of their families. However, a small group of patients suffered from clinically relevant anxiety; these patients should be given the support indicated for their specific distress.

Influence of kinship on donors' mental burden in living donor liver transplantation.

In the context of living donor liver transplantation (LDLT), German transplantation law stipulates that donor candidates should primarily be relatives of the recipients or persons with distinct and close relationships. In this study, we investigated the influence of the relationship between the donor and the recipient on the donor's emotional strain before transplantation. Donors were categorized according to the following subgroups: (1) parents donating for their children, (2) children donating for their parents, (3) siblings, (4) spouses, (5) other relatives, and (6) nonrelatives. The sample consisted of 168 donor candidates. Anxiety (F = 2.8, P = 0.02), depression (F = 2.6, P = 0.03), and emotional quality of life (F = 3.1, P = 0.01) differed significantly according to the relationship between the donor and the recipient. In comparison with healthy controls, parents donating for their children were significantly less stressed before LDLT and demonstrated fewer anxiety (P < 0.01) and depression symptoms (P < 0.05). Adult children donating for their parents demonstrated the highest mental burden and the lowest emotional quality of life. However, this was not due to the responsibility of these children for their own families because differences between donors with children and donors without children could not be ascertained. This group should be given special attention before LDLT and during follow-up visits, and psychological help should be provided when it is necessary.

Depression and protective factors of mental health in people with hepatitis C: a questionnaire survey.

BACKGROUND: Most studies investigating the effects of chronic hepatitis C (HCV) infection on the central nervous system have focused on cognitive impairment or on the health-related quality of life, but only few on depression. OBJECTIVES: This study investigated depression in HCV-infected people. Sense of coherence and social support were surveyed as protective factors of mental health. METHODS: In a cross-sectional study-design, 81 HCV-infected people with mild liver disease, who were not receiving antiviral therapy, were surveyed by validated measures. Anxiety (HADS), depression (BDI), psychopathological symptoms (SCL-90-R), social support (F-SozU) and resilience (SOC) were assessed. RESULTS: Higher levels of depression than normal controls (p=.001) and a wide range of psychological symptoms were associated with HCV infection. Women, single participants, and persons with a shorter interval after first diagnosis exhibited significantly higher scores of depression. Gender and sense of coherence predicted depression scores in HCV people (R(2)=.42, p<.001). CONCLUSIONS: The expression of depression in HCV-infected people is modulated not only by biological but also by psychological factors of mental health. Sense of coherence as a protective factor has a significant impact on the degree of depression. Furthermore, the high prevalence of depression and anxiety among persons not receiving antiviral therapy justifies psychosocial screening and support for HCV people independent of antiviral therapy.

[Screening for distress in women with breast cancer diagnosed for the first time: employment of HADS-D and PO-Bado]. / Screening von psychischen Belastungen bei erst erkrankten Brustkrebspatientinnen: Einsatz von HADS-D und PO-Bado.

OBJECTIVES: In the context of an intensification of efforts to ensure sufficient psychooncological care for breast-cancer patients, the discussion concerning valid psychometric screening instruments gains a special relevance. METHODS: The discriminant and diagnostic validity of HADS-D and PO-Bado were investigated in a sample of 123 women with breast cancer diagnosed for the first time. RESULTS: An ROC analysis revealed a cut-off score of greater than 9 for the subscale anxiety (sensitivity: 50%; specificity: 90%) for the use of HADS-D among breast cancer patients, whereas the recommended cut-off value was greater than 7 (sensitivity: 56%; specificity: 80%) for the subscale depression. Based on the anxiety and depression scores measured by HADS-D, 74% of the clinical cases could be classified correctly. Scores for physical and mental distress measured with PO-Bado were significantly lower in the investigated sample than in the control sample. CONCLUSIONS: HADS-D has only a moderate sensitivity for the group at hand. PO-Bado is a comprehensive basic documentation for specific psychooncological distress, though without cut-off values it is not useful as a screening instrument.

Mental and physical quality of life in actual living liver donors versus potential living liver donors: a prospective, controlled, multicenter study.

In a quasi-experimental design, we investigated the quality of life (QOL) in actual liver donors (n = 43) and potential liver donors (n = 33) before and 3 months after liver transplantation. This is the first study in this field combining a prospective design with an adequate control group. Potential donors served as a control group because they also had a relative in need of a liver transplant and were as emotionally involved with the recipient as actual donors, but they were not subjected to the donor operation. Groups did not differ in age, gender, marital status, donor-recipient relationship, urgency of transplantation, or recipient group (adult versus child). Actual donors showed decreased physical QOL, whereas potential donors were not affected. However, for both groups, a decrease in anxiety was found. Furthermore, actual donors showed a better mental QOL postoperatively than potential donors. The recipients of these 2 groups did not differ with respect to postoperative complications. Furthermore, the groups did not report a different caregiver burden, but actual donors showed higher self-esteem. Because of the surgery, the worsening of physical symptoms in actual donors was expected. It is remarkable, however, that although actual donors still showed a limited physical QOL 3 months after the operation, in both groups, a similar reduction in anxiety could be observed, and actual donors even demonstrated a better mental QOL postoperatively than potential donors. The latter might be due to a psychological benefit that actual donors derived from the fact that they were able to help the recipients.

Sense of coherence and social support predict living liver donors' emotional stress prior to living-donor liver transplantation.

The protection of the donors from physical or emotional harm has been a fundamental principle in living-donor liver donation from the beginning. Psychosomatic donor evaluation aims at the selection of eligible donors and the screening and exclusion of psychiatrically vulnerable donors. As clinical interviews may include subjective biases, efforts should be made to establish objective criteria for donor assessment. In recent research, protective factors have been reported to be a significant force behind healthy adjustment to life stresses and can be investigated as possible predictors of donors' eligibility. Being the central construct of Antonovsky's theory of salutogenesis, the sense of coherence is one of the most surveyed protective factors and a good predictor of individuals' stability when experiencing stress. Furthermore, family support has been shown to be a valuable protective resource in coping with stress. This study surveyed whether sense of coherence and social support predict donors' emotional strain prior to transplantation. Seventy-one donor candidates were included in the study during the donor evaluation prior to living-donor liver transplantation. Sense of coherence proved to be a significant predictor for all criterion variables, namely anxiety, depression and mental quality of life. In addition to this, donor candidates who were classified as eligible for donation in the psychosomatic interview had significantly higher values on sense of coherence total scores compared with rejected donors. In a multiple regression analysis, sense of coherence and social support together yielded a prediction of depression with an explained variance of 22% (R(2) = 0.22). Sense of coherence and social support can be implemented as self-rating instruments in the psychosomatic selection of donors and would help to further objectify donors' eligibility.

Selection of donors for adult living-donor liver donation: results of the assessment of the first 205 donor candidates.

Psychosomatic assessment for living liver donors for adults has as yet not been described in detail. Between August 1998 and September 2003, 205 donor candidates were admitted for psychosomatic evaluation; 13.2% of whom (N=27) were excluded. Mental disturbances, especially when accompanied with social stress, were frequent reasons for exclusion. Selected donors had higher social status with regard to education and employment rate than other donor candidates. Candidates with better psychosocial resources are selected in the psychosomatic evaluation, and this contributes to the good psychosocial outcome of living donors.

Psychological strain in urgent indications for living donor liver transplantation.

The ethical soundness of living donor liver transplantation (LDLT) in urgent indications is still under discussion. The aim of the survey was to investigate the psychological distress of donors in cases of hepatocellular carcinoma (HCC) or acute liver failure (ALF). In a prospective multicenter study (n = 123), health-related quality of life (QOL), anxiety, and depression were measured. The psychological distress of donors was correlated to the degree of urgency of the recipients' indication, which was classified as nonurgent, HCC, or ALF. During the donor evaluation prior to LDLT, the donors with recipients for HCC and ALF demonstrated significantly reduced mental QOL in comparison to donors for a nonurgent indication and to the German normative sample. Compared to healthy controls, anxiety and depression were significantly increased in donors for ALF. Three months after the transplantation, scores for mental QOL as well as for anxiety and depression improved and were within the normal range for the whole group as well as for the ALF donors. In conclusion, the psychological burden was temporary in nature. Our findings can be considered as arguments for the current practice to address family members as donors in cases of HCC and ALF.

[Stabilisation of abstinence by means of psychoeducation for patients with alcoholic liver disease awaiting liver transplantation]. / Stabilisierung der Abstinenz durch Psychoedukation für alkoholabhängige Patienten vor Lebertransplantation.

BACKGROUND: A manualised six-month psychoeducational intervention was conducted in patients with alcoholic liver disease and abstinence problems who were waiting for a transplantation. OBJECTIVES: In a naturalistic design it was investigated whether the intervention could improve patients' alcohol abstinence. METHODS: Between January 2002 and November 2003, 72 patients were enrolled in the therapeutic intervention, 48 of whom participated in group therapy. Health-related quality of life (SF-12), anxiety and depression (HADS-D), symptom strain (BSI) and social support (F-SOZU) were measured. Alcohol abstinence was examined in each group session by measuring the alcohol concentration in breath. RESULTS: At the beginning and end of the group therapy patients showed subsyndromal measures of anxiety and depression and minor symptoms of psychopathology. Physical quality of life was reduced (t = -8.694; df = 44; p < .001). Mental quality of life was in the range of the normative sample and was correlated with depression (r = -0.400; p = .009). Patients perceived high social support (t = 8.213; df = 45; p < .001). During the course of therapy four patients had relapses but the remaining patients stayed abstinent. Physical quality of life improved (t = -2.275; df = 27; p = .031), mental quality of life and symptom strain remained stable. CONCLUSIONS: The therapy presented here facilitated a stabilisation of mental well-being in patients with alcoholic liver disease who were waiting for organ transplantation. The relapse rate measured by alcohol concentration in breath remained low.

Quality of life and psychiatric complications after adult living donor liver transplantation.

We investigated the psychosocial effects of a right hepatectomy on donors for adult living donor liver transplantation (ALDLT). Questionnaires were sent to 66 actual donors, who had undergone ALDLT between August 1998 and September 2003, as well as to 139 potential donors, who had been examined as possible candidates for ALDLT; the latter had been excluded and had not undergone surgery. All actual donors reported full recovery within an average period of 14.41 (standard deviation = 8.86) weeks; all had returned to their preoperative employment. In preparation for ALDLT, they had received significantly more support from their families in the decision-making process than the potential donors had (t = 2.02; degree of freedom = 79; P = 0.047); they also felt better informed about donation than the potential donors (t = 2.04; df = 64; P = 0.045). Psychiatric problems occurred in 6 (14%) female donors in the perioperative period, mostly in connection with unrealistic outcome expectations. Donors with severe postoperative complications (n = 3) demonstrated higher scores of psychiatric symptoms (chi-square = 6.39; df = 2; P = 0.041). When we compared potential and actual donors, a significant difference in emotional quality of life was not demonstrated (t = 0.41; df = 76; P = 0.684), and it corresponded to that of the normative sample. For donors, perceived emotional quality of life did not depend on the course of recovery of the recipients. Six to 9 months after donation, potential donors reported a significantly higher physical quality of life than actual donors (t = 2.20; df = 56; P = 0.032). In conclusion, female donors, donors with their own major complications, or donors with unrealistic outcome expectations should be provided with adequate psychosocial care. With regard to the psychosocial outcome, ALDLT is a safe intervention for the donor.