Hi ineedtoknow-ga,
Well, other than the first report I mention below, you are right,
there is very little out there in the way of actual numbers when
talking about suicide and transplant recipients. I have found a few
studies which promise such data, but unfortunately most are not
available online.
The information on depression is far more accessible. I found quite a
number of articles where at least the abstracts were available, thus
providing the basic data. Most of these articles are available for
purchase online.
I’ve broken up the results of my research by type of transplant, since
there seems to be a difference in outcome depending on the organ
transplanted. For example, I noticed that depression is less prevalent
in heart transplant recipients than in liver transplant recipients.
Where the full text of the article is not available for free online,
I’ve labelled each link as either BIBLIOGRAPHY (meaning no other data
is available) or as ABSTRACT (meaning you can read the abstract
online). In either of those cases you may be able to purchase the
full text article online, as in the case of the BioMedNet articles, or
at least you will have enough information to find the articles at your
local university or medical library. (Alas, not EVERYTHING is online
yet!)
This first report that I found is comprehensive enough to warrant its
own section in this answer, so we’ll start there
==========================================================
AUSTRALIA AND NEW ZEALAND DIALYSIS AND TRANSPLANT REGISTRY.
==========================================================
This large annual report covers the treatment outcomes and causes of
death of Australian and New Zealander kidney patients, both dialysis
and transplant dependent. The report is detailed and provides exact
numbers of deaths related to suicide of kidney transplant recipients.
One excerpt –
Australia - Transplant Dependent Patients
“There were 109 deaths (2.5 deaths per 100 patient years at risk) of
patients with a functioning transplant, less than the previous year;
2.3% of patients with a functioning graft during the year … There were
two deaths from suicide.”
The full report with graphs and details is available for download as a
zipped pdf file. When you unzip the file you’ll see that the report is
broken into 14 pdf files. The section that applies to your question is
named:
c6deaths.pdf
Interesting to note in that report [P 52] is that in the Australia
patient group there were, as mentioned above, two suicides, but also
one case of “refusal of treatment” which one could assume was, in
essence, a suicide. In the New Zealand group there was one case of
refusal of treatment.
You should also notice that the incidence of refusal of treatment for
dialysis patients (as opposed to those who have received transplants)
is extremely high – 18 in the New Zealand group, 77 in the Australian
group.
Data above are from –
The Twentieth Report 1997
AUSTRALIA AND NEW ZEALAND DIALYSIS AND TRANSPLANT REGISTRY
http://www.anzdata.org.au/anzdata/anzdatareport/20thReport/deaths.htm
An overview of the transplant data used in the above report
Renal Transplants Performed in 1996
http://www.anzdata.org.au/anzdata/anzdatareport/20threport/transplant.htm
For comprehensive data, ANZDATA provides all of the annual reports for
the past six years. They can be downloaded from here --
Reports for other years 1996 – 2001 –
The Annual Reports of the ANZDATA Registry
http://www.anzdata.org.au/anzdata/AnzdataReport/report.htm
=======================================
SUICIDE IN LIVER TRANSPLANT RECIPIENTS
=======================================
BIBLIOGRAPHY
Riether, A. M., & Mahler, E. (1994). Suicide in liver transplant
patients. Psychosomatics, 35, 574-577.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=7809360&dopt=Abstract
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.93032158&rendertype=full
=========================================
SUICIDE IN KIDNEY TRANSPLANT RECIPIENTS
=========================================
The issue with suicide and kidney transplant patients is that the
suicide rate amongst dialysis patients is very high, much higher than
that of the general population or that of transplant recipients.
Hence, much of the discussion around suicide in kidney patients
compares rates between dialysis patients and transplant patients.
“It is estimated that up to 7 percent of the general population
suffers from clinical depression. That figure rises dramatically for
people with renal disease—nearly 25 percent of people on dialysis
experience deep sadness and hopelessness that continues over several
months.”
http://www.sbhcs.com/services/renal/newsletter/mental.html
-----------------------
“Approximately one-fourth of dialysis patients are depressed at any
one time, and 2.7 percent of transplant patients experience affective
psychosis. In addition, about 1 percent of the dialysis patients will
commit suicide.”
Psychiatric issues in renal dialysis and transplantation
Hosp Community Psychiatry 1983 Jul;34(7):623-8.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6350150&dopt=Abstract
-----------------------------------
“…[dialysis] deeply disrupts normal life and not surprisingly,
dialysis patients have a suicide rate 14 times higher than average. On
the other hand, those who have had a kidney transplant suffer no
greater suicide rate.
Cleveland Clinic Foundation
The NHS's great kidney failure ( Independent ) 3/25/96
http://www.patientsupport.net/news5.htm
----------------------------------
ABSTRACT
“The suicide rate was 15.7 versus 9.0 deaths per 100,000 person-years
in the general population (P< 0.001).”
Long-term survival in renal transplant recipients with graft function
Akinlolu O. Ojo, Julie A. Hanson, Robert A. Wolfe, Alan B. Leichtman,
Lawrence Y. Agodoa, and Friedrich K. Port
Kidney International; Volume 57 Issue 1 Page 307 - January 2000
http://www.blackwell-synergy.com/servlet/useragent?func=synergy&synergyAction=showAbstract&doi=10.1046/j.1523-1755.2000.00816.x&abbrev=Kidney%20Int&vol=57&page=307&goto=abstract
-----------------------------------
ABSTRACT –
Multiple drug overdose in a kidney transplant patient.
Zylber-Katz E, Putterman C, Caraco Y.
Ther Drug Monit 1994 Jun;16(3):327-31
Clinical Pharmacology Unit, Hadassah University Hospital, Jerusalem,
Israel.
“Development of depression in patients with organ transplants is
accompanied by an increased incidence of suicide attempts.”
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=8085287&dopt=Abstract
--------------------------
ABSTRACT
“During … September 1974 through August 1979, two hundred nine
consecutive patients received their first kidney transplant in Denver.
During 2.5 to 7.5 years of follow-up, 54 patients (26%) died.
Infection was the leading cause of death during all intervals and was
responsible for 22 (41%) of the 54 deaths…. other causes of death were
cardiovascular problems in 11 patients (20%), suicide in eight
patients (15%)…”
Causes of death after kidney transplantation.
Washer GF, Schröter GP, Starzl TE, Weil R
JAMA 1983 Jul 250:49-54
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.83216559&rendertype=full
=====================================
DEPRESSION AND TRANSPLANTS - GENERAL
======================================
Understanding that suicides are almost always preceded by depression
is a good first step to understanding how suicide relates to
transplant patients. A good overview of the relationship between
depression and suicide can be found here –
E-MEDICINE - Depression and Suicide
http://www.emedicine.com/EMERG/topic129.htm
Then understanding that depression often follows transplant surgery is
important –
“Depression is perhaps the most common problem and one of the most
difficult and unexpected aspects of organ transplant. Estimates
indicate that 5-22% of renal dialysis patients, 16% of lung transplant
candidates, and 9% of liver transplant candidates suffer from major
depression. Many more have less serious forms of depression, anxiety,
or other problems adjusting to their illnesses.”
Depression and Organ Transplant, by Alan Koike, M.D
http://transplant.ucdmc.ucdavis.edu/newsletter/newsletters/spring98/html/depression.html
----------------------------------
“… liver transplant recipients suggests that at least mild depression
is seen in close to 20 percent of patients. Pancreas transplants can
be associated with depression...”
“….Recent studies suggest that 25 percent of heart transplant
recipients are at risk for major depression three years after
transplant….”
Mental Health —Nov 2000
Emotional Aspects of Transplants
by Diane L. Bearman, Ph.D., L.P., William Robiner, Ph.D., L.P. Health
Psychology, Department of Neurology
http://www.fairviewtransplant.org/emotional_aspects.htm
------------------------------------
“Researchers at the Medical College of Wisconsin in Milwaukee, and at
the Dana-Farber Cancer Institute found that patients with depressive
symptoms six months after their transplant have higher risk of death
by one year post-transplant”
Link Between Depression and Death in Stem Cell Transplant Recipients
http://www.newswise.com/articles/2001/12/CANCER5.MCW.html
--------------------------------
BOOK CHAPTER
Examines key psychosocial issues facing the patient, family, and
transplant team
Psychosocial Aspects of Transplantation
http://www.transweb.org/qa/asktw/answers/answers9701/96070606.html
* this site requires free registration and log in.
==========================================
DEPRESSION AND TRANSPLANTS - LIVER
==========================================
*all abstracts below will require free registration and loggin to
BioMedNet. Full articles can be purchased on the site. I’ve summarized
the abstracts for you to save you time and to give you an idea of the
scope, focus, and results of the study.
ABSTRACT
“CONCLUSION: Recurrent HCV hepatitis in liver transplant recipients
is associated with impairment in quality of life, functional status,
and greater depression compared with patients who did not have HCV and
those without HCV recurrence.”
Quality of life, functional status, and depression in male liver
transplant recipients with recurrent viral hepatitis C.
Quality of life, functional status, and depression in male liver
transplant recipients with recurrent viral hepatitis C.
Singh N, Gayowski T, Wagener MM, Marino IR
Transplantation 1999 Jan 67:69-72
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.99118771&rendertype=full
----------------------------------------------
ABSTRACT
“Two hundred thirty-six of 375 patients (63%) who entered the study
returned the questionnaires, and 186 of these patients could be
included in the assessment… Physical factors of depression, age, and
employment and mental factors of anxiety and depression were
significant for predicting health-related quality of life after liver
transplantation.”
The relevance of anxiety, depression, and coping in patients after
liver transplantation.
Nickel R, Wunsch A, Egle UT, Lohse AW, Otto G
Liver Transpl 2002 Jan 8:63-71
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.21657532&rendertype=full
------------------------------------------------
ABSTRACT
“The psychological functioning of 20 adult liver transplant candidates
was evaluated… clinically significant levels of depression and anxiety
were reported for 28% and 37% of the sample, respectively…”
Psychological adjustment of liver transplant candidates.
Rodrigue JR, Davis GL, Howard RJ, Brunson ME, Langham MR, Haiman S,
Behen J
Clin Transplant 1993 Jun 7:228-9
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.93905346&rendertype=full
------------------------------------
ABSTRACT
“The emotional adaptation of 25 children who had undergone successful
liver transplantation at least 1 year previously was evaluated and
compared with that of a control group of 26 children with diabetes
mellitus… On projective measures, liver transplant recipients had an
increased number of depressive experiences, situationally related
internal distress, and a greater tendency toward negative self-focus
and evaluation….”
Emotional adaptation in children after liver transplantation.
Windsorová D, Stewart SM, Lovitt R, Waller DA, Andrews WS
J Pediatr 1991 Dec 119:880-7
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.92071809&rendertype=full
-----------------------------
ABSTRACT
“prospective study compared psychiatric, neurocognitive, and
quality-of-life changes of heart and liver transplant patients. The 51
heart and 61 liver transplant candidates … showed significant
improvements after transplant in neurocognitive functioning,
depressive symptoms, and quality of life…”
Quality-of-life changes and psychiatric and neurocognitive outcome
after heart and liver transplantation.
Riether AM, Smith SL, Lewison BJ, Cotsonis GA, Epstein CM
Transplantation 1992 Sep 54:444-50
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.93032158&rendertype=full
============================================
DEPRESSION AND TRANSPLANTS – HEART
===========================================
ABSTRACT
“The intent of this study was to measure health-related quality of
life and depression in 94 heart transplant recipients…. Our results
suggest that as early as 4 months after heart transplantation,
patients show excellent functioning … Patients did not generally
experience problems with depression within the first 4 months after
heart transplantation.”
Changes in health-related quality of life and depression in heart
transplant recipients.
Fisher DC, Lake KD, Reutzel TJ, Emery RW
J Heart Lung Transplant 1995 Mar-Apr 14:373-81
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.95298824&rendertype=full
------------------------------------
ABSTRACT
“Selected psychosocial outcomes were assessed in 49 pediatric heart
transplant recipients and their families from five heart
transplantation centers. Heart transplant recipients did not appear
significantly different from their peers on self-report measures of
self-concept and anxiety, but they showed significantly less social
competence and more behavior problems than a normative..”
The psychosocial impact of pediatric heart transplantation.
Uzark KC, Sauer SN, Lawrence KS, Miller J, Addonizio L, Crowley DC
J Heart Lung Transplant 1992 Nov-Dec 11:1160-7
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.93090788&rendertype=full
------------------------------
ABSTRACT
“This study examined the psychological and cognitive status of
patients presenting for heart transplant evaluation…This patient group
was characterized by impaired verbal memory and a tendency toward
depression and anxiety. The second part of the study examined changes
in psychological and cognitive status … follow-up assessment 1 year
after transplantation. The results indicated that psychological
distress (depression, anxiety) and several indices of cognitive
function improved after transplantation.”
Psychological and cognitive status before and after heart
transplantation.
Deshields TL, McDonough EM, Mannen RK, Miller LW
Gen Hosp Psychiatry 1996 Nov 18:62S-69S
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.97092259&rendertype=full
--------------------------------
ABSTRACT
“…a representative sample of 191 heart transplant recipients in a
prospective examination of the prevalence, clinical characteristics,
and risk factors for DSM-III-R major depressive disorder (MDD),
generalized anxiety disorder (GAD), associated adjustment disorders,
and posttraumatic stress disorder related to transplant (PTSD-T)
during the 3 years postsurgery…”
Prevalence and risk of depression and anxiety-related disorders during
the first three years after heart transplantation.
Dew MA, Kormos RL, DiMartini AF, Switzer GE, Schulberg HC, Roth LH,
Griffith BP
Psychosomatics 2001 Jul-Aug 42:300-13
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.21387743&rendertype=full
======================================
DEPRESSION AND TRANSPLANTS – KIDNEY
======================================
ABSTRACT
“Kidney transplant patients and their spouses (n = 121 couples) rated
their overall stress, social support, and adjustment following
transplantation…. Overall stress was related to lower marital
satisfaction and increased depression for both patients and spouses.”
Stressors, social support, and adjustment in kidney transplant
patients and their spouses.
Frazier PA, Davis-Ali SH, Dahl KE
Soc Work Health Care 1995 21:93-108
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.96124321&rendertype=full
---------------------------
BIBLIOGRAPHY
Depressive symptoms and kidney transplant outcome.
Rocha G, de Figueiredo CE, d'Avila D, Saitovitch D
Transplant Proc 2001 Nov-Dec 33:3424
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.21625646&rendertype=full
------------------------------
BIBLIOGRAPHY
The role of grief and fear in the death of kidney transplant patients.
Eisendrath RM
Am J Psychiatry 1969 Sep 126:381-7
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.69259695&rendertype=full
-------------------------------
ABSTRACT
“We are using a validated questionnaire (SF-36) to annually assess
health-related quality of life (QOL) in kidney and pancreas-kidney
transplant recipients…. For both diabetic and nondiabetic recipients,
average scores were higher than reported norms for patients with CHF,
COPD, or depression but were similar to those with Htn or recent MI.
Individual scores were then compared with age-matched means (+/- 2
SEMs) (95% C.I.) for the US population.”
Long-term quality of life after kidney and simultaneous
pancreas-kidney transplantation.
Matas AJ, McHugh L, Payne WD, Wrenshall LE, Dunn DL, Gruessner RW,
Sutherland DE, Najarian JS
Clin Transplant 1998 Jun 12:233-42
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.98306484&rendertype=full
=======================================
DEPRESSION AND TRANSPLANT – LUNG
=======================================
ABSTRACT
The purpose of this study was to examine the psychological functioning
and quality of life (QOL) of lung transplant candidates and
recipients…. CONCLUSIONS: Although lung transplant recipients have
better general, physical, and psychological health than their
pretransplant counterparts, the present research suggests that both
groups experience impairment in several areas of psychological
functioning.”
Psychological functioning and quality of life in lung transplant
candidates and recipients.
Limbos MM, Joyce DP, Chan CK, Kesten S
Chest 2000 Aug 118:408-16
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.20396022&rendertype=full
------------------------------
ABSTRACT
“Quality of life (QOL) studies of lung transplant recipients indicate
that there are improvements following transplantation. More recently,
there has been some suggestion that certain QOL issues are different
for men and women… CONCLUSIONS: Overall QOL improves following lung
transplantation; however, the lack of differences in many domains of
QOL raises the concern that women lung transplant recipients may
continue to have significant impairments, including those regarding
sexuality and body satisfaction.”
Quality of life in female lung transplant candidates and recipients.
Limbos MM, Chan CK, Kesten S
Chest 1997 Nov 112:1165-74
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.98033275&rendertype=full
==================================================
DEPRESSION AND TRANSPLANT – MULTIPLE TRANSPLANTS
===================================================
ABSTRACT
“This study examined depression, anxiety, and anger-hostility symptom
levels, as well as overall quality of life, in a cohort of 50 lung and
heart-lung transplant recipients.”
Psychological symptom levels and their correlates in lung and
heart-lung transplant recipients.
Stilley CS, Dew MA, Stukas AA, Switzer GE, Manzetti JD, Keenan RJ,
Griffith BP
Psychosomatics 1999 Nov-Dec 40:503-9
http://research.bmn.com/medline/jbrowse/record?uid=MDLN.20048680&rendertype=full
==============================
FURTHER INFORMATION
==============================
BIBLIOGRAPHIES
If you have access to a university library or to the Medline full text
database, you will be able to find most of these articles. Some I
found online in more than one online source, so have provided both in
case you already have access to one of the sites.
Molassiotis A, Morris PJ: Suicide and suicidal ideation after marrow
transplantation. Bone Marrow Transplant 1997 Jan; 19(1): 87-90
http://www.nature.com/cgi-taf/DynaPage.taf?file=/bmt/journal/v19/n1/abs/1700605ab.html&dynoptions=doi1037810564
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&Dopt=r&uid=97165177
House RM Thompson TL ; Psychiatric aspects of organ transplantation..
JAMA (1988 Jul 22-29) 260(4):535-9
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=3210280&dopt=Abstract
Rosser R; Depression during renal dialysis and following
transplantation.. Proc R Soc Med (1976 Nov) 69(11):832-4
Sensky T; Psychiatric morbidity in renal transplantation.. Psychother
Psychosom (1989) 52(1-3):41-6
Jenkins PL Roberts DJ; Suicidal behaviour after bone marrow
transplantation.. Bone Marrow Transplant (1991 Feb) 7(2):159-61
Why do some recipients stop taking their medications (and "waste"
their transplants)?
http://www.transweb.org/qa/asktw/answers/answers9701/96070606.html
--------------------------
BOOKS
Disease, Pain, and Suicidal Behavior
by Elsebeth Stenager, Egon Stenager
Haworth Press; ISBN: 078900111X; (June 1998)
(Includes section on Liver transplant patients)
HAWTHORN PRESS
http://www.haworthpressinc.com/store/product.asp?sku=1603
AMAZON
http://www.amazon.com/exec/obidos/tg/detail/-/078900111X/qid=1037807705/sr=8-1/ref=sr_8_1/102-7247620-5757703?v=glance&s=books&n=507846
--------------------------------
ONLINE BOOK –
SURVIVING TRANSPLANTATION
http://www.psychiatry.med.uwo.ca/survive/
excerpt –
“For example, few transplant patients expect that they or their
support person could ever become depressed. But statistics
consistently show that depression is a common complication of medical
illness of any kind. … Depressed support people are less available to
the transplant patients they wish to help. ..”
http://www.psychiatry.med.uwo.ca/survive/st1b.htm
----------------------------------
GENERAL ONLINE RESOURCES
American Association of Suicidology
http://www.suicidology.org/index.cfm
------------------------------
So, that should provide you with ample background on the prevalence of
depression and suicide amongst organ transplant recipients. If any of
the links don’t work or if something I’ve said isn’t clear, please
feel free to ask for a clarification. I’d be happy to follow up for
you.
Thanks so much for your question. It was certainly an interesting
search!
-K~
My search strategy was primarily to use the search function in the
medical journal databases, Medline and BioMedNet. I used combinations
of the terms
"kidney transplant" depression
"liver transplant" depression
"kidney transplant" suicide … and so forth.
Biomednet
http://journals.bmn.com/search/site/results
PubMed
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?CMD=&DB=PubMed
I also used Google and search terms such as:
"suicide rate" "transplant recipients"
"suicide rate" "heart transplant" |
