Prospective randomized study of individual and group psychotherapy versus controls in recipients of renal transplants

Abstract

Recipients of kidney transplant have been shown to develop emotional problems. These have been associated with medical noncompliance, compromised quality of life, and difficulty integrating the newly acquired transplant into their sense of self. In general, group psychotherapy has been shown to be more cost effective than individual therapy. We have compared the efficacy of two modalities of therapy in recipients of kidney transplants with control patients who did not receive therapy. Recipients of first cadaver kidney transplants were randomized into two groups to receive a 12-week course of group or individual psychotherapy. The control arm of the study was composed of 37 consecutive patients who had received a first cadaver kidney. Recipients of live kidney transplants, and patients who received more than one kidney transplant, were excluded because these patients have different emotional issues. The Beck Depression Inventory (BDI) was used as a measure of change in emotional state, pretherapy, at 3, 6, 9, and 12 months. A higher score on BDI was suggestive of psychologic dysfunction. We recruited 89 recipients of first cadaver kidney transplants into the study. They were randomly allocated into the two study groups, 49 for individual therapy, and 40 for group therapy. Of these, 82 patients completed 12 weeks of therapy (45 patients from the individual treatment arm, and 37 from the group therapy arm). Fifty-five patients completed one-year follow-up (33 in individual therapy, and 32 in the group therapy). The mean score was 26.3 +/- 7.9 before and 18.9 +/- 9.0 after therapy in the individual treatment group (P= 0.001). This was in comparison with a mean score of 30.2 +/- 3.8 before and 26.0 +/- 4.2 after therapy for the group therapy arm (P= 0.01). Improvement appeared to be more significant in the individual therapy compared with group therapy (P= 0.01). Lowering of scores was progressive and sustained (P= 0.01). In the control arm, mean score was 9.4 +/- 5.4 before and 20.5 +/- 5.5 at the end of the first year (P= 0.005), suggesting a significant worsening of BDI scores. Multivariate analysis of age, gender, employment status, duration of dialysis, etiology of kidney failure, diabetes mellitus, and psychotherapy received at any time before transplantation did not affect results. We conclude that both individual and group psychotherapy were beneficial to our patients; however, individual therapy was found to result in lower BDI scores versus group therapy at the end of treatment period.