Recipients and their families psychological adaptation following cardiac transplantation must be considered when evaluating the ultimate costs of utilizing this procedure. Little is known about the occurrence or course of clinically significant levels of psychiatric disorder among recipients in the extended period following initial hospital discharge, or whether chronic stresses emanating from recipients post-transplant status affect the mental health of their primary family caregivers. Most important, despite assertions that both parties mental health are critical predictors of recipients medical compliance and hence, of their physical health and ultimate survival, systematic research to document such relationships is lacking. The proposed study addresses clinical and epidemiologic questions pertaining to (a) the distribution and course of selected clinical and subclinical psychiatric conditions among recipients and their caregivers, (b) the relationship of both parties mental health to recipients medical compliance and cardiac-related physical health and (c) the extent to which both parties psychosocial characteristics not only place these persons at risk for post-transplant psychiatric disorder, but moderate effects of disorder on compliance and physical health. All adults surviving the initial post-transplant acute care period at Presbyterian University Hospital, Pittsburgh, PA, will be contacted for study. A total of 245 such recipients are anticipated during the enrollment period. Their family caregiver will also be interviewed. Interviews will be conducted at 2-, 6-, 12-months post-transplant, and will assess depressive and anxiety-related conditions (with the SCID); subclinical psychological symptoms; recipients medical compliance; perceptions of recipients physical health; and psychosocial characteristics in personal (e.g., coping style), environmental (e.g., social support) and predispositional (e.g., mental health history) domains. Additional health history and compliance data will be obtained from medical records and Transplant Program staff evaluations. An ultimate aim of the analyses is to refine hypotheses about the causal sequence of effects under investigation and thereby to revise the study's conceptual model for application to subsequent longitudinal and/or intervention efforts with these cohorts.
