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
ARTICLE HIGHLIGHTS
Research background

Depression, anxiety, and status of self-care ability are among the most important factors affecting the quality of life of patients who have undergone liver transplantation. Depending on the severity of the underlying liver disease, signs and symptoms of anxiety and depression may become more pronounced.

Research motivation

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 are found to affect self-care capability, depression, and anxiety.

Research objectives

The main objective of this study is to analyze the relationship between sociodemographic characteristics, presence of biliary complications, presence of hepatocellular carcinoma, preference of recommendation of liver transplantation to others, and frequency of out-patient clinic control, and some post-transplant quality of life indicators (depression, anxiety, self-care ability).

Research methods

This study is descriptive, cross-sectional questionnaire-based study on patients transplanted between 2002 and 2018 at our Liver Transplant Institute. The recipients who were discharged that were equal to or greater than 18-years-old and who can communicate verbally and understand and answer the questions were included in the present study. We interviewed 320 liver transplant recipients in the present study considering the proportion of the recipients with missing data. Of those, 316 recipients who answered the questionnaire forms accurately were included in the present study. The dependent variables were 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.

Research results

Self-care ability scores were lower and anxiety scores were higher in recipients with biliary complications. On the other hand, in recipients with hepatocellular carcinoma, self-care scores were lower and depression and anxiety scores were higher. In liver transplantation recipients with a monthly income < 3000 Turkish liras had higher depression and anxiety scores. The recipients who stated that they would not recommend liver transplantation to others had lower self-care scores and higher depression, state anxiety, and trait anxiety scores.

Research conclusions

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

Research perspectives

To our knowledge, this study is one of the most comprehensive studies examining the relationships between post liver transplant quality of life indicators and various clinical parameters.