Beneficial Impact of Group Psychotherapy on Depression and Quality of Life in Cirrhotic Patients on the Liver Transplant Waiting List

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Abstract

Introduction

It is well known that there is a high incidence of depression in patients on the liver transplant (LT) waiting list. Moreover, these patients usually present with deterioration in their quality of life. However, there have been few studies about psychological intervention on patients on the transplant waiting list that have assessed both of these aspects. Objectives: to assess the impact of group psychotherapy on psychopathological symptoms and on the quality of life of these patients.

Materials and Methods

Study population: patients on the LT waiting list who received group psychotherapy (n=15). Patient selection was carried out randomly using the list of patients waiting for a LT. Measurement instruments: Beck's depression test, which was provided before psychotherapy was initiated and after it was completed (after 6 months, with a total of 12 sessions). The Nottingham Health Profile (NHP) was used to assess the quality of life. It consists of 38 items belonging to six health dimensions: Energy, Pain, Physical mobility, Emotional reaction, Sleep and Social isolation. The score is obtained by calculating the average of the addition of affirmative answers for each dimension, the higher the score the worse the assessment. The two tests were completed at the same point in time. The group psychotherapeutic method consisted of having a discussion about patients' emotions and feelings. The role of the therapists was to facilitate the expression of emotions and to give meaning to them. Those patients who received a transplant were excluded and those patients who did not attend more than 6 group psychotherapy sessions were also excluded (>50%).

Results

Three patients were given a transplant before the psychotherapy had finished and five patients were excluded for not having attended more than 50% of the sessions (three attended two sessions and two attended three sessions). Therefore, the study was completed on 7 patients. The indication of LT was due to chronic alcoholic liver disease in four patients (all were Child-Pugh class B), two patients had HCC (both were Child A), and one patient had chronic hepatitis C virus (Child B). Initially 5 patients had depression-related symptoms; one patient had moderate depression, and four patients had intermittent states of depression. When the second survey was administered, all the patients improved in their psychopathological assessment (Table 1). Table 2 shows the average assessment for the six dimensions of quality of life before and after therapy. Overall, a better assessment can be seen in the second questionnaire.

Conclusion

Our data suggest an improvement in depressive symptoms and quality of life in patients on the LT waiting list after receiving group psychotherapy. Assuming that these results were confirmed in a larger number of patients, it would be interesting to implement group psychotherapy in the largest number of LT units possible.

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