Posttraumatic stress and medication adherence in pediatric transplant recipients

Abstract

Pediatric transplant recipients must maintain stable immunosuppression to prevent rejection and organ loss, yet medication nonadherence rates are unacceptably high. 1,2 Adolescent recipients are more likely to become nonadherent as they age 2-4 ; however, intervention efforts have shown limited success. 5 A promising (but understudied) approach is related to the association between nonadherence and posttraumatic stress symptoms (PTSS).In posttraumatic stress disorder (PTSD), psychiatric symptoms emerge following exposure to a potentially traumatic event (PTE). To meet the definition of a disorder, individuals must endorse symptoms from four clusters (i.e., intrusion, avoidance, negative alterations in cognitions and mood, and changes in arousal/reactivity) as well as substantial distress and/or dysfunction. 6 While these diagnostic criteria are important for identifying individuals most in need of psychiatric treatment, subthreshold symptomatology (i.e., PTSS) may still be associated with increased risk for clinically significant distress or impairment. 7,8

Pediatric Medical Traumatic Stress in Inflammatory Bowel Disease, Pancreatitis, and Cystic Fibrosis

“…The observed prevalence of child PTSD in our study was higher than the 11.5% average prevalence of PTSD reported in that study, which included cancer, burn, traumatic head injury patients alongside other chronic illnesses that more closely mirror our population. When comparing our findings to other studies of PMTS in non-cancer pediatric-onset chronic illnesses using the PTSD-RI and IES-R, we note similar or lower prevalence of medical PTEs, patient PMTS, and patient and parent PTSD (11,15,31–33).…”

“…Child PMTS was measured by a modified version of the UCLA PTSD Reaction-Index (PTSD-RI) self-report survey. This survey is validated in those 7 years and older, and has been extensively used to evaluate posttraumatic stress in pediatric illness populations (12)(13)(14)(15)(16). It is divided into 2 sections: the first assesses exposure to PTEs and the second evaluates symptoms of posttraumatic stress.…”

Pediatric Liver Transplantation: Long-Term Follow-Up Issues

“…In this context, the role of physicians is essential, both to monitor that patients continue to use their posttransplant medications and to monitor that patients adhere to their routine control visits. 75 Screening to identify nonadherence risk is of upmost importance. In fact, disagreements are frequent among parents and children about freedoms or responsibilities, particularly on the patient health status during teenage years.…”

“…Children affected by end-stage liver disease face imminent risk of death; thus, LT represents a life-saving operation, as does a lifelong treatment, heavily relying on daily medications and ongoing monitoring of graft function to prevent and treat possible complications, arising not only from the surgical procedure but also from the immunosuppression itself. 75 The psychological toll from the entire transplant experience can leave emotional scars that persist in the long term, particularly in grown children who feel "different" from their peers. The concept of survivorship, 78 which originally was applied to patients with cancer, acknowledges the ongoing spectrum of care and support that transplant patients require for issues related to noncompliance and cognitive function.…”

Social support and transplantation

“…The occurrence of potentially traumatic events and posttraumatic growth has also been examined in caregivers of pediatric transplant recipients. Caregiver rates of PTSS likely to meet the criteria for posttraumatic stress disorder ranged from 11.3 to 43.7% and caregivers reported higher levels of PTSS when their child experienced a medical complication in the previous year [26,27]. However, navigating stressful events can lead to posttraumatic growth.…”