Transplant Psychiatry

Annotated Abstracts of Journal Articles
2014, 1st Quarter

Transplant Psychiatry

Annotations by Paula Zimbrean, MD, FAPM
March 2014

  1. Risk Factors for Depression in Patients Undergoing Hematopoietic Cell Transplantation

PUBLICATION #1 — Transplant Psychiatry
Risk Factors for Depression in Patients Undergoing Hematopoietic Cell Transplantation

Artherholt SB, Hong F, Berry DL, Fann JR
Biol Blood Marrow Transplant 2014 Mar 18 [Epub ahead of print]

ANNOTATION (Paula Zimbrean)

The Finding: 31% of recipients of hematopoietic cell transplantation (HCT) have moderate or higher depression at 6-7 weeks post-transplantation (only 6% had same findings pre-transplantations). The depression score at T1 was a significant predictor for depression at T2.

Strength and Weaknesses: This is a prospective cohort study of 228 patients who were assessed at T1 (pre-HCT) and at T2 (6-7 weeks post-HCT) with the following instruments: Symptoms Distress Scale (SDS), European Organization for Research and Treatment of Cancer (EORTC) QLQ, Pain Intensity Numerical Scale, and Patient Health Questionnaire (PHQ9). The main limitation of this study is relative high socio-economic status of the group, which may affect the rate of depression, as well as limited number of assessments (only one pre- and one post-HCT) which might miss positive findings either in the pre-HCT phase or during the longer term follow up.

Relevance: This is an important study for clinicians implementing mental health services for patients with HCT. Based on this study, screening for depression pre-HCT may identify patients at risk for depression post-HCT and allow appropriate intervention. The study did not show, however, any predictive factors for depression in this group.


Despite the prevalence and known adverse impacts of depression after hematopoietic cell transplantation (HCT), little is known about the trajectory of depression occurring after HCT, or which pretransplantation risk factors might help predict new or worsening post-HCT depression. This secondary analysis evaluated the relationships between pre-HCT patient-reported outcomes and demographic characteristics and post-HCT depression. A total of 228 adult HCT patients were evaluated pre-HCT (T1) and again at 6 to 7 weeks post-HCT (T2), using touch-screen computers in the transplantation clinic during participation in a larger trial. Measures evaluated included the Symptom Distress Scale, the EORTC QLQ-C30 for quality of life, a single-item pain intensity question, and the Patient Health Questionnaire -9 for measurement of depression. At T1, rates of depression were quite low, with only 6% of participants reporting moderate or higher depression. At T2, however, the prevalence of moderate or higher depression was 31%. We observed a strong linear relationship in PHQ-9 scores between T1 and T2 (P < .0001). Depression score at T1 was a significant predictor of depression score at T2 (P = .03), as was poorer emotional function at T1 (P < .01). Our results indicate that post-HCT depression is common, even in patients with a low pre-HCT depression score. Frequent screening for symptoms of depression at critical time points, including 6 to 7 weeks post-HCT, are needed in this population, followed by referrals to supportive care as appropriate.