Factors affecting anxiety, depression, and self-care ability in patients who have undergone liver transplantation

Table 1 Sociodemographic characteristics of the study group

Parameters	n	%
Gender
Female	127	40.2
Male	189	59.8
Age (yr)
Median	50
IQR	58-36
BMI (kg/m2)
Median	25
IQR	28-22
Marital status
Married	245	77.5
Unmarried	58	18.4
Divorced	13	4.1
Residency
City Center	175	55.4
Town	106	33.5
Village	35	11.1
Levels of education
Unschooled	48	15.2
Primary school	156	49.4
Secondary school	23	7.3
High school	61	19.3
Bachelor's degree or more	28	8.9
Career
Housewife	90	28.5
Employed	27	8.6
Retired	78	24.7
Tradesman	40	12.7
Unemployed	81	25.6
Monthly income (Turkish liras)
≤ 1000	18	5.7
1000-3000	260	82.3
≥ 3000	38	12.0
Chronic disease (except liver disease)
Yes	113	35.8
No	203	64.2
Smoking (pre-LT)
Yes	127	40.2
No	189	59.8
Smoking (post-LT)
Yes	12	3.8
No	304	96.2
Alcohol use (pre-LT)
Yes	37	11.7
No	279	88.3
Alcohol use (post-LT)
Yes	7	2.2
No	309	97.8

BMI: Body mass index; IQR (Q3-Q1): Inter-quartile range.

Table 2 Clinical characteristics of the study group associated with liver transplantation

Parameters	n	%
Underlying liver disease
HBV	157	49.7
Cryptogenic	25	7.9
HCC	32	10.1
Wilson	15	4.7
HCV	19	6.0
Autoimmune	22	6.9
Others	46	14.5
Type of LT
LDLT	291	92.1
DDLT	25	7.9
Biliary complications
Presence	200	63.3
Absence	116	36.7
Antiviral agents use (HBV/HCV)
Yes	196	62.0
No	120	38.0
Ursodeoxycholic use
Yes	229	72.5
No	87	27.5
Tacrolimus use
Yes	286	90.5
No	30	9.5
Everolimus use
Yes	108	34.2
No	208	65.8
Corticosteroid use
Yes	96	30.4
No	220	69.6
Mycophenolate mofetil use
Yes	212	67.1
No	104	32.9
PPI Inhibitors use
Yes	314	99.4
No	2	0.6
Inclination towards recommendation of LT to others
I recommend	285	90.2
I do not recommend	31	9.8
Frequency of out-patient visits
Monthly	264	83.5
Quarterly	52	16.5

DDLT: Deceased donor liver transplantation; HBV: Hepatitis B virus; HCC: Hepatocellular carcinoma; HCV: Hepatitis C virus; LDLT: Living donor liver transplantation; LT: Liver transplantation.

Table 3 Evaluation of the Study group according to the scores obtained Self-Care Agency Scale, Beck Depression Scale and State-Trait Anxiety Scale

Parameters	Results
SCAS scores
Median	95
IQR	108-86
BDS scores
Median	9
IQR	14-5
STAI-I (state) scores
Median	35
IQR	41-28
STAI-II (trait) scores
Median	42
IQR	50-36
STAI-I (state) (categorized form)
Presence anxiety (≥ 35 point)	164 (51.9)
Absence anxiety (< 35 point)	152 (48.1)
STAI-II (trait) (categorized form)
Presence anxiety (≥ 35 point)	275 (87.0)
Absence anxiety (< 35 point)	41 (13.0)
BDS (categorized form)
Minimal depression (0-9 point)	183 (57.9)
Mild depression (10-16 point)	85 (26.9)
Moderate depression (17-29 point)	45 (14.2)
Severe depression (30-63 point)	3 (0.9)

BDS: Beck Depression Scale; IQR (Q3-Q1): Inter-quartile range; SCAS: Self-Care Agency Scale; STAI: State-Trait Anxiety Scale.

Table 4 Comparison of various characteristics of the study group according to presence of postoperative biliary complications

Parameters	Biliary complications (+) (n = 200)	Biliary complications (-) (n = 116)	P value
Age (yr)			0.126
Median	48	53
IQR	56-36	60-40
Gender (%)			0.533
Female	83 (41.5)	44 (37.9)
Male	117 (58.5)	72 (62.1)
BMI (kg/m2)			0.038
Median	26	25
IQR	28-22	27-22
Type of LT			< 0.001
LDLT	194 (97)	97 (83.6)
DDLT	6 (3)	19 (16.4)
SCAS scores			0.002
Median	94	98
IQR	108-82	107-89
BDS scores			0.375
Median	9	9
IQR	15-5	12-7
STAI-I (state) scores			0.004
Median	37	32
IQR	43-29	41-27
STAI-II (trait) scores			0.454
Median	42	42
IQR	50-36	54-37
BDS (categorized form)			0.040
Minimal depression	114 (57)	69 (59.5)
Mild depression	52 (26)	33 (28.4)
Moderate depression	34 (17)	11 (9.5)
Severe depression	0(0)	3 (2.6)
STAI-I (state)			0.009
Presence anxiety	115(57.5)	49(42.2)
Absence anxiety	85(42.5)	67(57.8)
STAI-II (trait)			1.000
Presence anxiety	174 (87.0)	101 (87.1)
Absence anxiety	26 (13.0)	15 (12.9)

BDS: Beck Depression Scale; BMI: Body mass index; IQR (Q3-Q1): Inter-quartile range; SCAS: Self-Care Agency Scale; STAI: State-Trait Anxiety Scale.

Table 5 Comparison of various characteristics of the study group according to presence of hepatocellular carcinoma

Parameters	HCC (+) (n = 32)	HCC (-) (n = 284)	P value
Age (yr)			0.195
Median	52	50
IQR	59-44	58-36
BMI (kg/m2)			0.063
Median	26	25
IQR	29-23	28-22
Gender (%)			1.000
Female	13 (40.6)	114 (40.1)
Male	19 (59.4)	170 (59.9)
Biliary complications			0.147
Presence	16 (50)	184 (64.8)
Absence	16 (50)	100 (35.2)
SCAS scores			0.006
Median	92	96
IQR	95-68	108-86
BDS scores			0.003
Median	13	9
IQR	17-8	13-5
STAI-I (state) scores			0.856
Median	34	35
IQR	50-26	41-28
STAI-II (trait) scores			0.009
Median	45	42
IQR	56-39	50-36
BDS (categorized form)			0.004
Minimal depression	10 (31.3)	173 (60.9)
Mild depression	12 (37.5)	73 (25.7)
Moderate depression	10 (31.3)	35 (12.3)
Severe depression	0 (0)	3 (0.9)
STAI-I (state) (categorized form)			0.968
Presence anxiety	16 (50)	148 (52.1)
Absence anxiety	16 (50)	136 (47.9)
STAI-II (trait) (categorized form)			0.402
Presence anxiety	30 (93.8)	245 (86.3)
Absence anxiety	2 (6.2)	39 (13.7)

BDS: Beck Depression Scale; BMI: Body mass index; IQR (Q3-Q1): Inter-quartile range; SCAS: Self-Care Agency Scale; STAI: State-Trait Anxiety Scale.

Table 6 Comparison of various characteristics of the study group according to monthly income

Parameters	≤ 1000 TL (n = 18)	1000-3000 TL (n = 260)	≥ 3000 TL (n = 38)	P value
Age (yr)				0.921
Median	44	51	50
IQR	60-30	58-36	57-43
Gender (%)				< 0.001
Female	13 (72.2)	107 (41.2)	7 (18.4)
Male	5 (27.8)	153 (58.8)	31 (81.6)
Residency (%)				0.002
City center	12 (66.7)	131 (50.4)	32(84.2)
Town	4 (22.2)	96 (36.9)	6 (15.8)
Village	2 (11.1)	33 (12.7)	0 (0)
SCAS scores				0.119
Median	94	94	97
IQR	109-86	105-86	112-87
BDS scores				< 0.001
Median	9	9	6
IQR	16-5	15-6	9-3
STAI-I (state) scores				0.106
Median	35	35	33
IQR	46-26	42-28	41-25
STAI-II (trait) scores				0.003
Median	48	42	39
IQR	52-43	50-36	45-36
BDS (categorized form)				0.004
Minimal depression	10 (55.6)	139 (53.5)	34 (89.5)
Mild depression	4 (22.2)	78 (30)	3 (7.9)
Moderate depression	4 (22.2)	40 (15.4)	1 (2.6)
Severe depression	0 (0)	3 (1.2)	0 (0)

BDS: Beck Depression Scale; IQR (Q3-Q1): Inter-quartile range; SCAS: Self-Care Agency Scale; STAI: State-Trait Anxiety Scale; TL: Turkish liras.

Table 7 Evaluation of the study group according to their inclination towards recommendation of liver transplantation to other patients

Parameters	I recommend (n = 285)	I do not recommend (n = 31)	P value
Age (yr)			0.519
Median	51	50
IQR	58-36	62-40
Gender (%)			1.000
Female	115 (40.4)	12 (38.7)
Male	170 (59.6)	19 (61.3)
Residency (%)			0.551
City center	155 (54.4)	20 (64.5)
Town	98 (34.4)	8 (25.8)
Village	32 (11.2)	3 (9.7)
Biliary complications			0.660
Presence	182 (63.9)	18 (58.1)
Absence	103 (36.1)	13 (41.9)
SCAS scores			0.002
Median	95	74
IQR	108-87	101-69
BDS scores			< 0.001
Median	9	15
IQR	13-5	29-9
STAI-I (state) scores			0.020
Median	35	42
IQR	41-28	51-27
STAI-II (trait) scores			< 0.001
Median	42	49
IQR	50-36	53-43
BDS (categorized form)			< 0.001
Minimal depression	173 (60.7)	10 (32.3)
Mild depression	79 (27.7)	6 (19.4)
Moderate depression	33 (11.6)	12 (38.7)
Severe depression	0 (0)	3 (9.8)
STAI-I (state) (categorized form)			0.095
Presence anxiety	143 (50.2)	21 (67.7)
Absence anxiety	142 (49.8)	10 (32.3)
STAI-II (trait) (categorized form)			0.021
Presence anxiety	244 (85.6)	31 (100)
Absence anxiety	41 (14.4)	0 (0.0)

BDS: Beck Depression Scale; IQR (Q3-Q1): Inter-quartile range; SCAS: Self-Care Agency Scale; STAI: State-Trait Anxiety Scale.

Table 8 Comparison of various characteristics of the study group according to frequency of out-patient clinic visits

Parameters	Monthly control (n = 264)	Quarterly control (n = 52)	P value
Age (yr)			0.047
Median	52	44
IQR	58-38	56-29
Gender (%)			1.000
Female	106 (40.2)	21 (40.4)
Male	158 (59.8)	31 (56.9)
Residency (%)			0.077
City center	150 (56.8)	25 (48.1)
Town	82 (31.1)	24 (46.2)
Village	32 (12.1)	3 (5.8)
SCAS scores			0.664
Median	95	94
IQR	108-86	108-87
BDS scores			0.028
Median	9	9
IQR	15-6	10-3
STAI-I (state) scores			0.728
Median	35	38
IQR	41-28	44-29
STAI-II (trait) scores			0.519
Median	42	40
IQR	50-36	50-36
BDS (categorized form)			0.004
Minimal depression	147 (55.7)	36 (69.2)
Mild depression	72 (27.3)	13 (25)
Moderate depression	44 (16.7)	1 (1.9)
Severe depression	1 (0.4)	2 (3.8)
STAI-I (state) (categorized form)			0.360
Presence anxiety	134 (50.8)	30 (57.7)
Absence anxiety	130 (49.2)	22 (42.3)
STAI-II (trait) (categorized form)			0.506
Presence anxiety	228 (86.4)	47 (90.4)
Absence anxiety	36 (13.6)	5 (9.6)

BDS: Beck Depression Scale; IQR (Q3-Q1): Inter-quartile range; SCAS: Self-Care Agency Scale; STAI: State-Trait Anxiety Scale.