408.2 Relationship between Medical Severity and Psychological Functioning in Pediatric Heart Transplant Patients During Hospital Admissions
Tuesday May 07, 2019 from 10:00 to 11:00
Seymour Room
Presenter

Kristine McKenna, United States

Transplant Psychologist

Pediatric Transplant Center

Boston Children's Hospital

Abstract

Relationship between Medical Severity and Psychological Functioning in Pediatric Heart Transplant Patients During Hospital Admissions

Kristine McKenna1, Jacqueline Nguyen1, Katharine Thomson1, Chase Samsel1, Patricia Ibeziako1.

1Pediatric Transplant Center, Boston Children's Hospital, Boston, MA, United States

Background: The current study examines how medical severity relates to psychological functioning among pediatric heart transplant patients who were seen by transplant psychology and psychiatry staff over a 6-year period at a tertiary pediatric hospital.

Methods: Chart reviews are being conducted for all heart transplant consultations between 2008 and 2014. Data include: (1) demographic information including age, gender, and race/ethnicity; (2) medical acuity including diagnoses, number of transplants, and reliance on devices (e.g., VAD, tracheostomy, dialysis); (3) psychiatric history including diagnoses and psychotropic medication usage; and (4) hospital variables such as length of ICU stay(s) and number of consultations by psychology/psychiatry.

Results: The transplant psychology and psychiatry team was consulted to provide care to 113 cardiology patients over the 6-year period. Ages ranged from 2 to 33 years old (M= 14.14; SD= 7.01), 57.5% were male, and race/ethnicity distribution was as follows: 69.9% White, 4.4% Black, 15.9% Latino, 2.7% Asian, 1.8% South Asian, 2.7% Middle Eastern, 2.7% Multiracial.  The most common psychiatric diagnoses at the time of consultation were adjustment disorders (54.9%), anxiety disorders (34.5%), followed by depressive and mood disorders (24.8%), and trauma disorders (0.9%). Roughly half of patients had been diagnosed with a congenital heart condition (43.2%), while 54.1% of patients had cardiomyopathy. Nearly 75% had at least one transplant (before or after consultation) and 70% of patients were still receiving care at the same hospital.

Conclusions: Adjustment disorders were more common in patients still living at the end of the data collection period which may indicate a potentially adaptive level of psychological arousal. Mild distress can promote use of active coping strategies, increased engagement in their health care, and vigilance about adhering to the medical regimen. Another possibility is that patients who eventually passed away in the hospital setting, especially in the ICU, were less likely to receive adjustment disorder diagnoses as opposed to other diagnoses (e.g., delirium). Psychological functioning likely affects clinical outcomes following transplant and identifying risk and resiliency factors for pediatric heart transplant patients is an important step in maximizing quality of life throughout the transplant process. In early analyses, patients with different cardiac diagnoses appear to have similar struggles with adjustment/coping and use of psychological services. This study does not assess long term outcomes (medical or psychiatric) but tracking patients’ psychological functioning throughout their transplant course could yield more information about how to help these individuals thrive throughout the process. A strengths-based approach may be particularly useful to fortify patients’ resilience and self-efficacy.


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