Figure 3: depression among patients waiting for liver transplantation
Out of 40 subjects waiting for liver transplantation, 27.5% has clinical depression i.e., moderate depression in 15%, borderline in 7.5% and severe depression in 5%. Thirty five percentage of the subjects were having mild mood disturbance and only 40% were found to be normal.
Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 127 Table 3: Association between depression and the risk factors of depression among patients waiting for solid
organ transplantation n = 60
Variables Category
depression
Χ2 value df p value No depression having depression
n % n %
Gender(#) Male 42 76.4 13 23.6
0.854* 1 0.034
Female 4 80 1 20
Family support (#) Yes 43 76.8 13 23.2
0.935** 1 0.007
No 3 75 1 25
Family History of
Depression (#) Yes 4 80 1 20 0.854* 1 0.034
No 56 79.2 13 24.5
H/o Stressful
life events (#) Yes 7 77.8 2 22.2 0.932** 1 0.007
No 39 76.5 12 23.5
Diagnosis CKD 15 75.0 5 25.0 4.848* 1 0.028
CLD 18 45.0 22 55.0
Co-morbid Medical
conditions (#) YesNo 1927 77.166 68 22.924 0.918* 1 0.011
χ2(1) = 3.84 ,x2(2) = 5.99 ns- not significant * - significant, p<0.05 (#) fisher’s exact test * significant, p<0.05 **- significant, p<0.01 Statistically significant associations were found
between depression and risk factors of depression like male gender (x2=0.854,df=1,p<0.05), lack of family support (x2=0.935,df=1,p <0.01), family history of depression (x2=0.854,df=1,p<0.05), history of stressful life events(x2=0.932,df=1,p<0.05), and presence of co-morbid medical conditions (x2 =0.918,df
=1,p<0.05). Depression was more seen in patients with chronic liver disease than chronic kidney disease (x2=4.848,df=1,P=<0.05).
dISCuSSION
According to this study which used Beck’s Depression inventory, 23.4% of the patients waiting for solid organ transplantation has clinical depression at various levels, 42% has mild mood disturbance and only 35% of the sample is considered as not having depression.
Twenty percentage of wait-list renal transplantation patients and 27.5% of wait-list liver transplantation patients are found to be clinically depressed.
One study reported that depressive symptoms are as common as one patient out of two of the cohort on waiting-list for kidney or liver transplantation6. The reason for such huge magnitude is that they assessed the symptoms of depression and these symptoms were mainly of mild intensity, ant to a lesser extent, of moderate intensity.
But in the current study, the investigators used a tool
for diagnosing clinical depression. In a study conducted among pre kidney transplant patients, 23% of the sample had demonstrated depression8 and another one reported that 24.8% of the prospective liver transplant candidates have major depression9. Many previous studies support the current study findings in liver transplantation candidates10,11,12.
The current study also found out the risk factors of depression among patients waiting for depression. Male gender, lack of family support, having family history of depression, history of stressful life events, and presence of co-morbid medical conditions were found to be significantly associated with depression. Also depression was more seen in patients with chronic liver disease than chronic kidney disease. Factors like marital status, social support, dependence on others for activities of daily living, history of maternal deprivation in childhood, and alcohol abuse were not having association with depression. Nonfunctional family/social support had been associated with psychopathologic symptoms like depression in patients awaiting for liver transplant14.
Depression has been found to be associated with mortality during the waiting period for organ transplantation15. It has also been revealed that depression in pre-transplant period may continue in the post-transplant period, which is associated with complications like graft failure, non-compliance, various
128 Indian Journal of Public Health Research & Development, April-June 2018, Vol.9, No. 2 kinds of morbidity and mortality in patients6. Previous
studies report that pre-transplant psychological status predicts post-transplant psychological status, length of hospitalization, and even the success of the surgery16.
CONCluSION
All prospective organ transplantation candidates especially those with risk factors of depression must undergo thorough screening for depression and other psyhosocial evaluations. Prompt recognition and effective intervention for depression is thought to ensure the best outcomes for both patients and their families.
Source of Funding: Self.
Conflict of Interest: Nil.
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