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Feasibility of assessing adolescent and young adult heart transplant recipient mental health and resilience using patient-reported outcome measures. Journal of the Academy of Consultation-Liaison Psychiatry Brown, T., Chen, S., Ou, Z., McDonald, N., Bennett-Murphy, L., Schneider, L., Giles, L., Molina, K., Cox, D., Hoskoppal, A., Glotzbach, K., Stehlik, J., May, L. 2021

Abstract

BACKGROUND: Although adolescents and young adults (AYA) may be particularly prone to mental health symptoms following heart transplant, screening practices are variable. This study examined the feasibility of using patient-reported outcome (PRO) measures to assess mental health, functional status, and resiliency in post-transplant AYA patients.METHODS: Patients transplanted between ages 15-25 years at three centers completed six PRO instruments via web-based platforms: PROMIS instruments for anxiety, depression, satisfaction with social roles, and physical functioning; the Posttraumatic Stress Diagnostic Scale for DSM-V (PDS-5); and the Connor-Davidson Resilience Scale-10 (CD-RISC-10). Feasibility (completion, time to completion, and measure missingness) and PRO results were described and compared between congenital heart disease (CHD) and cardiomyopathy (CM) patients.RESULTS: Nineteen patients (median age at transplant 17.7 years [IQR 16.3,19.2 years], 84% male) were enrolled at an average of 3 ± 1.8 years post-transplant. Enrollment was 90% among eligible patients. Measure missingness were zero. The average completion time was 12 ± 15 minutes for all instruments. Timely PRO completion was facilitated by in-clinic application. The PRO results indicated that 9 patients (47%) had at least mild PTSD symptoms (=11 points on PDS-5). Among them, 4 patients had scores >28 suggestive of probable PTSD. Two (11%) and 6 (32%) patients had anxious and depressive symptoms, respectively. The CM cohort had a higher median PDS-5 score than that of the CHD subgroup (11.0 vs 6.0; p = 0.015). Twelve (63%) had resiliency scores that were lower than the population average. No significant differences were found in PRO results between CM and CHD patients apart from the PTSD assessment.CONCLUSIONS: This novel PRO-based approach to psychiatric screening of AYA patients after transplant appears feasible for assessing mental health, functional status, and resiliency, with excellent enrollment and completion rates. These instruments characterized the burden of mental health symptoms within this AYA heart transplant cohort, with a high prevalence of PTSD symptoms. Resiliency scores were lower than in a comparison population. Electronically- administered PRO administration could facilitate more consistent mental health screening in this at-risk group.

View details for DOI 10.1016/j.jaclp.2021.08.002

View details for PubMedID 34438097