Comparison of quality of life between two clinical conditions with immunosuppressive therapy: liver transplantation and multiple sclerosis.

OBJECTIVE: We aimed to compare quality of life in two clinical conditions treated with immunosuppressants: cadaveric liver transplant recipients and multiple sclerosis patients. We also assessed the clinical significance of these results regarding a representative age-adjusted sample of the general Spanish population. METHODS: Using a cross-sectional design, the SF-36 Health Survey was used to evaluate 62 patients with these chronic conditions (31 in each group) who were matched for gender. An analysis of covariance was performed to control for the influence of time from multiple sclerosis diagnosis and liver transplantation surgery until assessment. Student t test of covariate-adjusted mean values was used as the statistical test and Cohen's d effect size index, to assess the magnitude of intergroup differences and assess clinical significance. RESULTS: Significantly worse scores were observed among the neurological patients compared with transplant recipients regarding role-physical (P = .038), general health (P = .003), vitality (P = .034), and physical functioning (P = .049), with medium effect sizes (Cohen's ds from -0.511 to -0.785). Against normative values, liver transplant recipients displayed relevant differences in all SF-36 subscales (Cohen's ds from -0.569 to -0.974) except for mental health (small effect size). Likewise, multiple sclerosis patients showed much greater differences versus the general population (Cohen's ds from -0.846 to -1.760). CONCLUSIONS: Liver transplant recipients showed better quality of life than multiple sclerosis patients (medium effect sizes) in physical quality-of-life dimensions. Interestingly, despite having controlled for time from diagnosis/transplantation, both medical conditions showed clinically significant impairments (large and medium effect sizes) in physical and psychosocial quality-of-life domains. We concluded that transplant recipients belong to a population that still requires special health care because, even after having undergone their treatment of choice, they do not achieve normal levels of biopsychosocial functioning.

Biopsychosocial functioning in liver patients of alcoholic etiology as a function of self-perceived pain level.

OBJECTIVE: To compare the biopsychosocial functioning among liver transplantation and cirrhotic patients as a function of self-perceived pain level. METHODS: We selected two groups of liver patients of the same gender (men) and disease etiology (alcoholic): there were 39 liver transplant recipients and 34 severe cirrhotic patients. The Hospital Anxiety and Depression Scale and the SF-36 Health Questionnaire were used. We applied analysis of covariance, with age and model end-stage liver disease (MELD) scores as covariates to assess the influence of two independent factors: (1) group (liver transplant recipients and cirrhotic patients), and (2) self-perception of pain (mild and high). We also calculated Cohen's d as an effect size index. RESULTS: No interactive effects were found between factors group and self-perceived pain in any of the variables studied. With regard to the main effects, we found statistically significant differences in the following variables between: a) liver transplant recipients and cirrhotic patients: anxiety (P = .000), depression (P = .003), role-physical (P = .001), mental health (P = .016), general health (P = .000), vitality (P = .000), and physical functioning (P = .000); and b) liver patients with mild and high self-perceived pain: anxiety (P = .008), depression (P = .000), role-physical (P = .002), mental health (P = .000), vitality (P = .000), and physical functioning (P = .001). In all the indicated variables, with medium and large effect sizes (Cohen's ds from 0.58 to 1.64), the cirrhotic patients and patients with a high level of self-perceived pain had much poorer mental health and quality of life. CONCLUSION: Alcoholic cirrhotic male patients with a high level of self-perceived pain had the greatest biopsychosocial impairment, even exceeding the clinical threshold in the anxiety and depression scales; and the highest biopsychosocial well-being was associated with liver transplant recipients with a mild level of self-perceived pain.

Coping strategies in liver patients as a function of relatives' anxiety level.

OBJECTIVE: To determine whether differences in the coping strategies used by liver patients during the pretransplantation phase were a function of their relatives' level of anxiety. MATERIALS AND METHODS: We assessed 75 pre-liver transplantation patients and 75 relatives (one per patient). To assess relatives' anxiety status, we used the Hospital Anxiety and Depression Scale (HADS), and the Questionnaire of Coping with Stress in Cancer Patients (CAEPO) to study patients' coping strategies. Three subgroups of relatives were established as a function of their scores on the HADS anxiety subscale: normal anxiety (G(1)), dubious anxiety (G2), and clinical anxiety (G(3)). To verify intergroup differences in the coping strategies used by the patients, we used the nonparametric Kruskal-Wallis H test. We also performed pairwise comparisons with nonparametric Mann-Whitney U test (with Bonferroni's correction) and Cohen's d as an effect size index. RESULTS: Focusing on the most relevant effect sizes, the pairwise contrasts indicated the following differences: a) normal anxiety (G(1)) and dubious anxiety (G(2)): seeking social support (d = 0.502); b) normal anxiety (G(1)) and clinical anxiety (G(3)): coping and active fighting (d = 0.607), self-control and emotional control (d = 0.658), and seeking social support (d = 0.944); and c) dubious anxiety (G(2)) and clinical anxiety (G(3)): coping and active fighting (d = 0.743), self-control and emotional control (d = 0.722), and seeking social support (d = 0.515). CONCLUSION: In general, during the pre-liver transplantation study, the liver patients whose relatives showed clinical levels of anxiety used these three healthy coping strategies to a lesser extent: coping and active fighting, self-control and emotional control, and seeking social support.

Affective status in liver transplant recipients as a function of self-perception of general health.

OBJECTIVE: We aimed to determine whether there were differences with regard to anxiety and depressive symptomatology between liver transplant recipients with better (G(1)) versus worse (G(2)) self-perceptions of general health compared with pre-liver transplantation cirrhotic patients (G(3)). METHODS: The groups of patients included 168 recipients including 85 and 83 with better or worse self-perceptions of general health, respectively, and 75 cirrhotic pre-liver transplantation patients. For the psychological assessment we used the Hospital Anxiety and Depression Scale and the general health dimension of the SF-36 Health Questionnaire. The following analyses were used: Analysis of variance (ANOVA) with post hoc pairwise comparisons by means of Tukey's test and Cohen's d, an effect size index. RESULTS: Significant differences were observed among the three groups for the variables of anxiety (P = .000) and depression (P = .000). Specifically, liver transplant recipients with better self-perceptions of general health displayed lower scores (better mental health) compared with those showing worse self-perceptions or cirrhotic patients. There were no differences between the latter two groups. The differences in these variables were relevant (large effect sizes) for anxiety (Cohen's d(1-2) = -1.075, Cohen's d(1-3) = -1.155) and for depression (Cohen's d(1-2) = -1.145, Cohen's d(1-3) = -1.158). CONCLUSION: The anxious-depressive status was not necessarily better among liver transplant recipients. There was great variability among them as a function of self-perceived general health. Transplant recipients with worse self-perception of general health presented the same anxiety-depressive levels as patients with severe liver disease in the pretransplantation phase; the latter groups reach the clinical threshold on the depression scale.

Relatives' mental health during the liver transplantation process.

OBJECTIVE: To compare the mental health of relatives of liver transplant patients during the three phases: pretransplantation, waiting list, and posttransplantation. MATERIALS AND METHODS: This follow-up study used the Hospital Anxiety and Depression Scale (HADS) to assess the relatives of 35 liver transplant patients (one relative for each patient). The anxiety-depression status was compared across the three liver transplant phases: pretransplant study (G(1)), from the first to the third month after admission to the waiting list (G(2)), and the 3 months after liver transplantation (G(3)). Student t test for paired samples was used for statistical analysis, and Cohen d calculated as an effect size index. RESULTS: Significant differences were observed (P = .000) among the three phases in anxiety and depression variables. In both, the greatest affective symptomatology corresponded to the phases prior to the liver transplantation (G(1) and G(2)) and the lowest in the post-liver transplant stage (G(3)). Relevant differences (large effect size) were noted between pre- and posttransplant phases in both HADS subscales: anxiety (Cohen d(1-3) = 1.197; Cohen d(2-3) = 0.817) and depression (Cohen d(1-3) = 1.228; Cohen' d(2-3) = 1.239). CONCLUSION: Relatives show poorer mental health during the phases prior to liver transplantation compared with the posttransplantation.

Influence of relatives' anxious symptomatology on the quality of life of pretransplant hepatic patients.

OBJECTIVES: We sought to analyze the influence of anxiety symptoms of relatives of patients undergoing a pretransplant study on the quality of life of the hepatic patients body pain, physical role, mental health, general health, vitality, social functioning, emotional role, and physical functioning. MATERIALS AND METHODS: We assessed 2 groups: 51 patients with hepatic cirrhosis and 51 of their closest relatives who were studied while the patients were hospitalized to undergo the pretransplant study. We used a "Psychosocial Survey" (in both groups), the "Hospital Anxiety and Depression Scale" (HADS) in the relatives, and the "SF-36 Health Survey" (in the patients). RESULTS: The results showed that the patients whose relatives presented clinical levels of anxiety showed the worst quality of life, specifically for the dimensions "mental health" (P=.016) and "emotional role" (P=.041).

Comparison of anxious and depressive symptomatology among pretransplant hepatic patients and their relatives.

OBJECTIVE: We sought to compare the anxiety and depressive symptoms of patients undergoing pretransplant evaluation with those of their closest relatives. MATERIALS AND METHODS: We assessed 51 patients with hepatic cirrhosis and 51 relatives who were the main care giver for each patient. All subjects were assessed during the interval when the patients were hospitalized to undergo the medical assessment to determine their inclusion on the waiting list for liver transplantation. In both groups, we used a "Psychosocial Survey" and the "Hospital Anxiety and Depression Scale." RESULTS: Significant differences were observed in anxiety (P=.001), but not in depression (P=.820). Specifically, relatives presented higher levels of anxiety compared with the hepatic patients. CONCLUSION: The relatives were worse off psychologically than the patients.