PSYCHOSOCIAL PREDICTORS OF VULNERABILITY TO DISTRESS IN THE YEAR FOLLOWING HEART-TRANSPLANTATION

This study examines psychological symptomatology in a cohort of 72 hea rt transplant recipients followed longitudinally during their first ye ar post-transplant. In keeping with research on other domains of life stressors and illnesses, a central study goal was to identify pre-tran splant and perioperative psychosocial factors associated with increase d vulnerability to, and maintenance of, elevated psychological distres s levels post-transplant. Average anxiety and depression levels, but n ot anger-hostility symptoms, were substantially elevated in the early post-transplant period, relative to normative data. Average symptom le vels improved significantly over time, although one-third of the sampl e continued to have high distress levels at all follow-up assessments. Recipients with any of seven psychosocial characteristics at initial interview were particularly susceptible to. continued high average dis tress levels over time: a personal history of psychiatric disorder pri or to transplant; younger age; lower social support from their primary family caregiver; exposure to recent major life events involving loss ; poor self-esteem; a poor sense of mastery; and use of avoidance copi ng strategies to manage health problems. Recipients without such facto rs showed improvement in average distress levels across the assessment period. These effects were stronger for anxiety than depressive sympt oms, with the exception of a sizeable relationship between loss events and subsequent depression. The findings suggest that clinical interve ntions designed to minimize prolonged emotional distress post-transpla nt need to be closely;tailored to heart recipients' initial psychosoci al assets and liabilities.