Screening for Psychosocial Distress in PostLung Transplant Recipients Goals
Background Since the inception of the UPMC lung transplant program in 1982, over 2000 patients have received a cadaveric lung transplant. All potential transplant recipients are expected to meet with the multidisciplinary team for their pretransplant evaluation. Patients are required to have a thorough psychosocial assessment and have close follow up with social work during the evaluation and wait time phases. In-depth social work assessments in post lung transplant recipients (PLTR) has not been a requirement or standard of care in our center. Within a period of 4 months, two PLTR died as a result of suicide. These unfortunate events exposed the likelyunaddressed psychosocial and mental health needs in the post-transplant population and initiated the collaborative approach of social work, palliative care, and psychiatry to identify and intervene early in those who screen positive in order to prevent further devastating consequences.
Method: Development of plan
• Completed recent literature review of relevant studies • Reviewed various mental health screenings to determine best modality • Developed intervention plan to address the mental health needs with positive screens on PHQ-9 and/or GAD-7 Over the last 2 weeks, how often have you been bothered by the following problems? More than half Nearly every the days day 2 3 2 3 2 3
Not at all 0 0 0
Several days 1 1 1
4. Trouble relaxing 5. Being so restless that it's hard to sit still 6. Becoming easily annoyed or irritable
0 0 0
1 1 1
2 2 2
3 3 3
7. Feeling afraid, as if something awful might happen a. Little interest or pleasure doing things Add up your results for eachincolumn b. Feeling down, depressed, or hopeless c. Trouble falling/staying asleep, sleeping too much d. Feeling tired or having little energy e. Poor appetite or overeating
0 0 0 0 0 0
1 1 1 1 1 1
2 2 2 2 2 2
3 3 3 3 3 3
0
1
2
3
0
1
2
3
0
1
2
3
0
1
2
3
Not difficult at all
Somewhat difficult
Very Difficult
Extremely difficult
1. Feeling nervous, anxious or on edge 2. Not being able to stop or control worrying 3. Worrying too much about different things
f. Feeling bad about yourself or that you are a failure or have you let yourself or your family down g. Trouble concentrating on things, such as reading the newspaper or watching TV h. Moving or speaking so slowly that other people could have noticed. Or the opposite; being so fidgety or restless that you have been moving around a lot more than usual. i. Thoughts that you would be better off dead or of hurting yourself in some way Add up your results for each column Total Score: If you checked off any problem on this questionnaire so far, how difficult have these problems made it for you to do your work, take care of things at home, or get along withother people?
• Increase general understanding of the need for systematic screening of mental health in post-transplant population • Provide rational for longitudinal involvement of social work support for all transplant patients (pre and post) • Development of mental health screening process that can be duplicated for all transplant recipients
Sara B Maloney LCSW, MSW Rachel A Brown LCSW, MSW
Overall Results
• 35% of all patients had a positive PHQ-9 rating • 25% of all patients had a positive GAD-7 rating • 22% of all patients had both a positive PHQ-9 and GAD-7 rating
Methods: Implementation and Intervention
• Collaborated with the transplant team to execute needs assessment into posttransplant clinic visits • Within 3 weeks, 103 PLTR were assessed and all screens were scored by an Licensed Clinical Social Worker (LCSW) Gender
42, 41%
61, 59%
Male
• • • •
•
Female
Age Range: 21-77 years
Appropriate resources/interventions were provided with positive screens in either PHQ-9 or the GAD-7 Normal (0-4): no intervention needed Mild (5-9): Discussed symptoms with PLTR, local resources offered Moderate (10-14): Discussed symptoms with PLTR, recommended counseling and provided local resources and/or referral to Palliative Care, provided crisis resources Severe (15+ or active suicidality): Intervention as above for moderate screen, in addition to evaluation for SI/SA and/or inpatient psychiatric admission
Conclusions
• Significant numbers of post- transplant patients exhibit distress, as quantified by symptomatology of depression and anxiety • For those patients who endorse symptoms, a significant number of patient refuse services, even when directly- offered • Many post- transplant patients exhibited symptoms of both anxiety and depression
Next Steps
• Development of interventions to systematically address the psychosocial needs of post lungtransplant patients • Screening for distress in all post lung- transplant patients • Embedding applicable resources in the Comprehensive Lung Center • Increase team-wide discussion and awareness of post- transplant psychosocial needs and resources