Resilience is associated with low psychological distress in renal transplant recipients
Introduction
Renal transplantation (RT), as a well-established treatment for end-stage renal disease, has gained popularity worldwide for its high success rate. RT is a positive event for most patients, as it means they can discontinue dialysis. However, RT recipients might face several new challenges after kidney transplant surgery, such as intensive immune suppressive drug treatment, probability of organ rejection, tendency for infection and uncertainty about their social status, which may make them feel stressed and subsequently render them susceptible to psychological distress and disorders [1], [2], [3]. Indeed, RT recipients often report suffering from clinically relevant symptoms of psychological distress, such as depression and anxiety, after successful surgery [2], which substantially lowers their quality of life [4] and potentially interferes with treatment compliance [1]. It is therefore important to regularly screen and properly manage psychological distress in this population.
To date, sparse but emerging literature has identified several psychosocial factors related to psychological distress, such as personal attributes and environmental factors [5]. Studies of environmental resources have suggested that social support is a protective factor that could buffer against stress and independently reduce psychological distress [6], [7], [8]. Recently, the association between perceived social support and psychological distress has gained research attention; however, little is known about the effect of perceived social support on psychological distress among RT recipients.
As positive psychology is increasingly used to prevent and treat mental health problems, the role of resilience is being recognized. Resilience is widely acknowledged to be a complex and dynamic construct, which has been defined as “the process of adapting well in the face of adversity, trauma, tragedy, threats or even significant sources of threat”. It embodies personal qualities enable one to successfully adapt, maintain or regain individuals' mental health in the face of significant adversity or risk [9], [10]. Studies have suggested that people displaying resilience make better psychological adjustments in the face of acute or chronic stressors [11], [12], [13]. Individuals with high resilience cope with stressful events more efficiently [14], and show reduced psychological distress after exposure to stress or trauma [15], [16]. As RT has frequently been regarded as a potentially traumatic event, resilience might be expected to influence psychological distress in response to RT. However, to the best of our knowledge, the exact nature of the association between resilience and psychological distress has not yet been elucidated among RT recipients.
In this cross-sectional study, we anticipated that higher levels of resilience in RT recipients would predict better mental health status after the traumatic event of RT. This study was designed to explore (1) the level of psychological distress among RT recipients, and (2) the relationship between resilience and psychological distress after adjusting for perceived social support. We hope that our results will contribute to understanding the role of resilience in improving the mental health status of RT recipients, as well as provide clinical staff and family caregivers with information on psychological interventions and psychological care programs for RT recipients.
Section snippets
Participants and procedures
This cross-sectional study was performed between July 2013 and September 2014. The RT survivor patients were recruited from the RT follow-up clinic and ward in the Departments of Nephrology of three general hospitals in Jinan, China. Inclusion criteria for the patients were (a) at least 18 years old; (b) an interval of at least 1 year after RT; (c) stable clinical condition, namely, the absence of any infection or acute complication; (d) no consciousness disorders; (e) no current psychotic
Results
The mean (± S.D.) age of the participants was 37.3 (± 10.9) years; 74.1% were male, 73.4% were married, 42.4% had lower monthly incomes (<¥1000) and 56.8% had already returned to work. All patients had relatives as the kidney source. The average time since RT was 3.02 (± 2.51) years, ranging from 1 to 16 years, and the average duration of dialysis before transplantation was 9.42 (± 14.22) months; 43.9% experienced complications, including rejection reactions (10.8%), pulmonary infections (23.7%) and
Discussion
This study is the first attempt to examine psychological distress status and its link with resilience in RT recipients. Given the life-threatening nature of RT, as well as the uncertain health outcomes, psychological distress in RT survivors is common. In the present study, 42.4% of RT recipients experienced significant moderate or severe psychological distress, which is slightly higher than rates found during the equine influenza outbreak [21] and much higher than those observed in rural
Acknowledgements
The study was supported by grants from Shandong Province Natural Science Foundation (ZR2015HM064), the Innovation Foundation for Young Talent Team of Shandong University (IFYT15010), the Department of Science and Technology of Shandong Province (2015ZDXX0801A01) and the Fundamental Research Funds of Shandong University (2015QY001). We are thankful for the generous contributions of the research participants and the staff who assisted with data collection during the study.
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The first author and the second author contributed equally to this work.