Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Oct 28, 2021; 27(40): 6967-6984
Published online Oct 28, 2021. doi: 10.3748/wjg.v27.i40.6967
Factors affecting anxiety, depression, and self-care ability in patients who have undergone liver transplantation
Sami Akbulut, Ali Ozer, Hasan Saritas, Sezai Yilmaz
Sami Akbulut, Sezai Yilmaz, Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Sami Akbulut, Ali Ozer, Department of Public Health, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Hasan Saritas, Department of Surgical Nursing, Siirt University Faculty of Nursing, Siirt 56100, Turkey
Author contributions: Akbulut S and Saritas H collected the data; Akbulut S and Ozer A performed the statistical analysis; Akbulut S and Ozer A wrote the manuscript; Akbulut S, Ozer A and Yilmaz S reviewed the final version of the manuscript.
Institutional review board statement: This study was reviewed and approved by the Inonu University institutional review board for non-interventional studies (2019/3-27).
Informed consent statement: Verbal and written consents were obtained from all living liver donor candidates.
Conflict-of-interest statement: The authors declare no conflicts of interest regarding this manuscript.
Data sharing statement: There are no additional data available for this study.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, MD, PhD, Professor, Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10.Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Received: July 6, 2021
Peer-review started: July 6, 2021
First decision: August 7, 2021
Revised: August 15, 2021
Accepted: October 11, 2021
Article in press: September 30, 2021
Published online: October 28, 2021
Processing time: 112 Days and 10 Hours
Abstract
BACKGROUND

Depression, anxiety, and altered self-care ability are among the most important factors affecting the quality of life of liver transplant recipients. Depending on the severity of the underlying liver disease, signs and symptoms of anxiety and depression may become more pronounced.

AIM

To evaluate the factors affecting depression, anxiety and self-care abilities of liver transplant recipients.

METHODS

Recipients who are ≥ 18 years and who underwent liver transplantation at Inonu University Liver Transplantation Institute were included in this descriptive and cross-sectional study. Sample size analysis showed that the minimum number of recipients should be 301 (confidence level = 95%, confidence interval = 2.5, population = 1382). Three hundred and twenty recipients were interviewed and 316 recipients that have answered the questionnaires accurately were analyzed. The dependent variables were the Beck Depression Scale, State-Trait Anxiety Scale (Form I and II), and Self-Care Agency Scale. The independent variables of the study were sociodemographic characteristics, biliary complications, hepatocellular carcinoma, recommending liver transplantation to other patients, and the interval of out-patient clinic visits.

RESULTS

Self-care ability scores were lower (P = 0.002) and anxiety scores were higher (P = 0.004) in recipients with biliary complications. On the other hand, in recipients with hepatocellular carcinoma, self-care scores were lower (P = 0.006) while depression (P = 0.003) and anxiety scores (P = 0.009) were higher. Liver transplantation recipients with a monthly income < 3000 Turkish liras had higher depression (P < 0.001) and anxiety (P = 0.003) scores. The recipients who stated that they would not recommend liver transplantation to others had lower self-care scores (P = 0.002), higher depression (P < 0.001), higher state anxiety (P = 0.02), and trait anxiety (P < 0.001) scores.

CONCLUSION

Presence of biliary complications and hepatocellular carcinoma, low income level, and an obligation for monthly visits to the outpatient clinic are factors that are found to affect self-care capability, depression, and anxiety.

Keywords: Liver transplantation; Biliary complications; Hepatocellular carcinoma; Socioeconomic status; Depression; Anxiety; Self-care capabilities

Core Tip: Depression, anxiety, and deficiency in self-care ability are among the most important factors affecting the quality of life of liver transplant recipients. This descriptive, cross-sectional questionnaire-based study shows that presence of biliary complications and hepatocellular carcinoma, low monthly income level, and monthly visits to the outpatient clinic are factors that affect self-care capability, depression, and anxiety.