Relationship between psychological problems and non-adherence in Dutch liver transplant recipients

Abstract

Background Non-adherence is recognized as a major health concern among transplant recipients and leads to poorer transplant outcomes. Psychological problems like depression, anxiety and post-traumatic stress (PTS) might increase the risk of non-adherence. However, evidence about this relationship is inconclusive.

Aims and research question To determine if there is a relationship between psychological problems and non-adherence in medication, monitoring signs and symptoms, taking blood tests and appointment keeping one year after liver transplantation, the following research question was posed: Is there a relationship between psychological problems and non-adherence in different treatment aspects in Dutch liver transplant recipients, one year after transplantation?

Methods A cross-sectional study was performed among Dutch liver transplant recipients from the University Medical Centre Groningen (UMCG) who were 1 years post-transplant.

Results Of the 71 participants included, 78.9% were non-adherent in some part of their treatment. Non-adherence in reporting vital signs was associated with depression (r= - 0.393, p=0.001), PTS (r= -0.374, p=0.001) and anxiety (r= -0.407, p= <0.000). Depression increased the risk of non-adherence in noting medications (OR= 11.7, CI [2.40 – 57.14]. PTS showed a significant association with appointment non-adherence (OR= 15.71, CI [3.19 – 77.33], p=0.001). Non-adherence with taking blood tests was associated with anxiety (OR= 4.378, [1.42 – 13.52], p=0.010). Multiple regression showed that younger age, female gender, unemployment and neurotic personality mediated this relationship.

Conclusion Non-adherence is prevalent to most aspects of treatment regimen and were associated with psychological problems.

Recommendations The results emphasize that there is a need to screen adherence and psychological problems after transplantation. Future research on the difference aspects of non-adherence and how this remains in the long term is needed