Survival is only one goal of lung transplantation (txp). Recipients' and their families' long-term psychological adaptation must be considered when evaluating costs and benefits of this therapy. Beyond clinical, accounts, there are no data on the occurrence or course of significant psychiatric disorder among recipients in the post-txp years. There are no data on whether the unique chronic stresses associated with lung txp affect the family caregiver's mental health. Despite assertions that both parties' mental health are critical predictors of recipients' medical compliance and, hence, of their long-term physical health and quality of life, empirical evidence of such effects is lacking. Concerning the latter outcomes, there has been no estimation of Quality-Adjusted Life Years (QUALYs) associated with various health statuses e.g., mental illness noncompliance that emerging post-txp. Consideration of outcomes such as QALYs is a necessary first step toward eventual economic cost effectiveness analyses comparing the impact of such conditions, and attempts to treat or avert them. The study will address clinical epidemiologic questions pertaining to (a) the distribution and course of selected clinical and subclinical psychiatric conditions among recipients and caregivers during the first 2 years post- txp; (b) the impact of post-noncompliance on recipients' ultimate txp- related physical health, quality of life, and QALYS. Face-to-face interviews, electronic medication monitoring, and medical record reviews will be conducted with all adult lung recipients surviving the initial post- txp acute care period at the University of Pittsburgh Medical Center (UPMC) during the study enrollment period (anticipated N=137). Interview will be conducted as recipients return to UPMC for routine follow-up at 2, 6, 12, 18, and 24 months post-txp. For comparison purposes, data will be collected at identical timepoints from a 115 heart recipients transplanted during the study enrollment period, and from a cross-sectional sample of 85 lung txp candidates. Family caregivers of all these persons will be interviewed as well. Interviews will assess depressive and anxiety-related conditions (with the SCID); recipients' medical compliance; perceptions of recipients' physical health; generic and disease-specific components of QOL; and psychosocial characteristics. In addition to electronic medication monitoring during the 2-year period, compliance and health data will be obtained from Txp Program staff evaluations and medical records. An ultimate aim of the analyses is to refine hypotheses about the predictive sequence of effects under investigation and thereby to revise the study's conceptual model for subsequent intervention efforts.
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