Post-Traumatic Stress Symptoms in Hematopoietic Stem Cell Transplant Recipients.
Post-Traumatic Stress Symptoms in Hematopoietic Stem Cell Transplant Recipients.
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DOI：
10.1016/j.jtct.2021.01.011
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发表时间：
2021-04
影响因子：
3.2
通讯作者：
El-Jawahri, Areej
中科院分区：
文献类型：
--
作者：
Fenech, Alyssa L.;Van Benschoten, Olivia;Jagielo, Annemarie D.;Ufere, Nneka N.;Topping, Carlisle E. W.;Clay, Madison;Jones, Bailey T.;Traeger, Lara;Temel, Jennifer S.;El-Jawahri, Areej
造血干细胞移植（HCT）是恶性血液病患者的一种强化且具有潜在疗效的治疗方法。因HCT入院的患者经历了长期的隔离住院，并忍受了大量的身体和心理症状。然而，HCT对移植受者创伤后应激障碍（PTSD）症状影响的研究缺乏。本研究对250例接受自体和异体HCT的患者进行了二次分析，使用创伤后应激障碍检查表-平民在HCT后6个月测量PTSD。我们使用《肿瘤治疗-骨髓移植功能评估》和医院焦虑抑郁量表来评估患者在HCT入院时、住院第2周和HCT后6个月的生活质量（QOL）和抑郁焦虑症状。我们使用多元回归模型来评估与PTSD症状相关的因素。考虑到生活质量、抑郁和焦虑症状之间的共线性，我们分别对它们进行建模。HCT后6个月出现临床显著PTSD症状的比率为18.9%（39/206）。具有临床显著PTSD症状的参与者经历了高警惕性（92.3%）、逃避（92.3%）和侵入（76.9%）症状。在无临床显著PTSD症状的患者中，24.5%存在临床显著的高警觉性症状，13.7%存在临床显著的回避症状。HCT入院时较低的生活质量（B = - 0.04, P = 0.004）和单身（B = - 3.35, P = 0.027）与HCT后6个月较高的PTSD症状相关。HCT入院时较高的焦虑（B = 1.34, P <.001）、HCT住院期间焦虑的变化（B = 0.59, P =.006）和单身（B = - 3.50, P =. 017）与6个月时较高的PTSD症状相关。在使用抑郁症的单独模型中，年龄较小（B = - 0.13, P = 0.017）、单身（B = - 3.58, P = 0.018）和较高的基线抑郁症状也与6个月时较高的PTSD症状相关（B = 0.97, P < 0.001）。大约五分之一接受HCT的患者在移植后6个月出现临床显著的PTSD症状。即使在没有临床显著PTSD症状的患者中，高警觉性和回避症状的患病率也很明显。预防和治疗HCT受者PTSD症状的干预措施显然是必要的。
Hematopoietic stem cell transplantation (HCT) is an intensive and potentially curative therapy for patients with hematologic malignancies. Patients admitted for HCT experience a prolonged, isolating hospitalization and endure substantial physical and psychological symptoms. However, there is a paucity of research on the impact of HCT on post-traumatic stress disorder (PTSD) symptoms in transplant recipients. This secondary analysis of 250 patients who underwent autologous and allogeneic HCT examined PTSD using the PTSD Checklist-Civilian measured at 6 months after HCT. We used the Functional Assessment of Cancer Therapy–Bone Marrow Transplant, and the Hospital Anxiety and Depression Scale to assess quality of life (QOL) and depression and anxiety symptoms at the time of admission for HCT, week 2 during hospitalization, and 6 months after HCT. We used multivariate regression models to assess factors associated with PTSD symptoms. Given collinearity between QOL, depression, and anxiety symptoms, we modeled these separately. The rate of clinically significant PTSD symptoms at 6 months after HCT was 18.9% (39/206). Participants with clinically significant PTSD symptoms experienced hypervigilance (92.3%), avoidance (92.3%), and intrusion (76.9%) symptoms. Among patients without clinically significant PTSD symptoms, 24.5% had clinically significant hypervigilance symptoms and 13.7% had clinically significant avoidance symptoms. Lower QOL at time of HCT admission (B = −0.04, P = .004) and being single (B = −3.35, P = .027) were associated with higher PTSD symptoms at 6 months after HCT. Higher anxiety at time of HCT admission (B = 1.34, P <.001), change in anxiety during HCT hospitalization (B = 0.59, P =.006), and being single (B = −3.50, P = .017) were associated with higher PTSD symptoms at 6 months. In a separate model using depression, younger age (B = −0.13, P = .017), being single (B = −3.58, P = .018), and higher baseline depression symptoms were also associated with higher PTSD symptoms at 6 months (B = 0.97, P < .001). Approximately one fifth of patients undergoing HCT experience clinically significant PTSD symptoms at 6 months after transplantation. The prevalence of hypervigilance and avoidance symptoms are notable even among patients who do not have clinically significant PTSD symptoms. Interventions to prevent and treat PTSD symptoms in HCT recipients are clearly warranted.
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影响因子：
3.7
作者：
Esser, Peter;Kuba, Katharina;Mehnert, Anja
通讯作者：
Mehnert, Anja
影响因子：
3.6
作者：
Kuba, Katharina;Esser, Peter;Mehnert, Anja
通讯作者：
Mehnert, Anja
影响因子：
3.3
作者：
Jacobsen, PB;Widows, MR;Fields, KK
通讯作者：
Fields, KK
影响因子：
6.2
作者：
El-Jawahri AR;Vandusen HB;Traeger LN;Fishbein JN;Keenan T;Gallagher ER;Greer JA;Pirl WF;Jackson VA;Spitzer TR;Chen YB;Temel JS
通讯作者：
Temel JS
影响因子：
3.4
作者：
Alter, CL;Pelcovitz, D;Kaplan, S
通讯作者：
Kaplan, S