Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis.

Yuri Battaglia,Michele Provenzano,Martino Belvederi Murri,Luigi Grassi,Alda Storari,Michele Andreucci,Luigi Zerbinati,Pasquale Esposito

doi:10.3390/jcm10204747

Abstract

Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.

Highlights

Kidney transplantation (KT) is the best treatment option for people affected by end stage chronic kidney disease (ESRD) [1]
134 consecutive kidney transplant recipients (KTRs) were included in this study; nine patients declined to participate and none was excluded
We report the level of Post Traumatic Growth by assessing post-traumatic growth (PTG) Inventory among KTRs and characterized, for the first time, the relationship of PTG with DS-IT, physical/emotional symptoms or problems via network analysis among patients who were submitted to kidney transplantation

Summary

Introduction

Kidney transplantation (KT) is the best treatment option for people affected by end stage chronic kidney disease (ESRD) [1]. Anxiety and depression, are presented in KTRs with a prevalence from 10% to 40%, depending on the measures used, such as the International Classification of Diseases (ICD). Other clinically significant psychosocial syndromes, not diagnosable with traditional psychiatric tools, were found in about 65% of KTRs. abnormal illness behavior, irritability, alexithymia and somatization were the most frequent syndromes assessed by Diagnostic Criteria for Psychosomatic Research (DCPR), a useful interview for identifying sub-threshold or undetected syndromes [6]. Demoralization, a psychological syndrome distinct from depression [7], has been diagnosed in a high percentage of medically ill patients [8], with a high prevalence of up to 86% in KTRs [9]. That is a condition described as a state of existential distress, characterized by loss of meaning and purpose in life, hopelessness and helplessness and feelings of “being trapped” because of persistently being unable to cope with a particular stressful situation [10]

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