© In e na ional Jou nal o Clinical and Heal h Psychology ISSN 1697-2600
2007, Vol. 7, Nº 3, pp. 633-639
Symp oms o anxie y and dep ession in di e en
s ages o o gan ansplan 1
Ma ía Ángeles Pé ez-San-G ego io2, Agus ín Ma ín-Rod íguez, and
An onio Galán-Rod íguez (Uni e sidad de Se illa, España)
(Recei ed Oc obe 31, 2006 / Recibido 31 de oc ub e 2006)
(Accep ed Janua y 7, 2007 / Acep ado 7 de ene o 2007)
ABSTRACT. F om his ex pos ac o s udy, we analysed i symp oms o anxie y and
dep ession o he pa ien s a ies a e ansplan in ela ion o he h ee main s ages o
he p ocess: a) In ensi e Ca e Uni (ICU – pa ien ecen ly admi ed o ICU a e
ansplan ), b) pos -ICU (when a pa ien comes ou o ICU bu emains in hospi al), and
c) pos -hospi al (when a yea has passed a e he ansplan ). 39 ansplan pa ien s
we e assessed in h ee di e en s ages: ICU, pos -ICU, and pos -hospi al. In each s age,
he Hospi al Anxie y and Dep ession Scale was applied and, in addi ion, du ing he i s
s age o he in o ma ion was ob ained (socio-demog aphic, medical, e c.) by way o a
psychosocial su ey. Pa ien s showed mo e symp oms o anxie y and dep ession in he
ICU and pos -hospi al s ages, diminishing in he pos -ICU s age. A e he o gan ansplan ,
i is no iced a psychological e olu ion in he shape o “U”, wi h an inc ease o
psychological well-being in he middle s ages.
KEYWORDS. Anxie y. Dep ession. O gan ansplan . Psychological s ages. Ex pos
ac o s udy.
RESUMEN. Desde es e es udio ex pos ac o, analizamos si los sín omas de ansiedad
y dep esión de los pacien es a ían después del asplan e en elación a las es ases
del p oceso: a) Unidad de Cuidados In ensi os (UCI – pacien e admi ido ecien emen e
1This esea ch was suppo ed by Fondo de In es igaciones Sani a ias (Ins i u o de Salud Ca los III) del Plan
Nacional de In es igación Cien í ica, Desa ollo e Inno ación Tecnológica.
2Co espondence: Depa amen o de Pe sonalidad, E aluación y T a amien os Psicológicos. Facul ad de
Psicología. Uni e sidad de Se illa. C/ Camilo José Cela, s/n. 41018 Se illa (España). E-Mail: [email p o ec ed]
634 PÉREZ-SAN-GREGORIO e al. Anxie y and dep ession in o gan ansplan
In J Clin Heal h Psychol, Vol. 7, Nº 3
en la UCI as el asplan e), b) pos -UCI (cuando el pacien e abandona la UCI pe o
pe manece en el hospi al) y c) pos -hospi al (cuando ha pasado un año as el asplan-
e). T ein a y nue e asplan ados ue on e aluados en es momen os di e en es: UCI,
pos -UCI y pos -hospi al. En cada ase se aplicó la Escala Hospi ala ia de Ansiedad y
Dep esión; además, du an e la p ime a ase se ob u o in o mación adicional
(sociodemog á ica, médica, e c.) a a és de una encues a psicosocial. Los pacien es
p esen aban los mayo es sín omas de ansiedad y dep esión en la UCI y en la ase pos -
hospi al, siendo meno es en la ase pos -UCI. Po lo an o, después del asplan e de
ó gano, se ap ecia una e olución psicológica en o ma de “U”, con un aumen o del
bienes a psicológico en las ases in e medias.
PALABRAS CLAVE. Ansiedad. Dep esión. T asplan e de ó ganos. Fases psicológicas.
Es udio ex pos ac o.
RESUMO. Nes e es udo ex pos ac o, analisámos se os sin omas de ansiedade e
dep essão dos pacien es a iam depois do ansplan e em elação às ês ases do p ocesso:
a) Unidade de Cuidados In ensi os (UCI – pacien e admi ido ecen emen e na UCI
depois do ansplan e), b) pós-UCI (quando o pacien e abandona a UCI mas pe manece
no hospi al) e c) pós-hospi al (quando passou um ano após o ansplan e). 39 ansplan ados
o am a aliados em ês momen os di e en es: UCI, pós-UCI e pós-hospi al. Em cada
ase aplicou-se a Escala Hospi ala de Ansiedade e Dep essão; além disse, du an e a
p imei a ase ecolheu-se in o mação adicional (sociodemog á ica, médica, e c.) a a és
de uma en e is a psicossocial. Os pacien es ap esen a am os maio es sin omas de
ansiedade e dep essão na UCI e na ase pós-hospi al, sendo meno es na ase pós-UCI.
Po conseguin e, depois do ansplan e de ó gãos, ap ecia-se uma e olução psicológica
em o ma de “U”, com um aumen o do bem-es a psicológico nas ases in e médias.
PALAVRAS CHAVE. Ansiedade. Dep essão. T ansplan e de ó gãos. Fases psicológi-
cas. Es udo ex pos ac o.
In oduc ion
Al hough o gan ansplan is associa ed wi h longe and be e quali y o li e, in
some pa ien s a a ie y o psychological complica ions may appea : anxie y, dep ession,
an asies abou he dono , dissa is ac ion wi h physical image, sexual di icul ies, eelings
o guil abou he dea h o he dono and g a i ude o he dono ’s amily, e c. (Kaba,
Thompson, Bu na d, Edwa ds, and Theodosopoulou, 2005; Pé ez, Ma ín, and Galán,
2005). In his con ex , i is o a g ea in e es o ake in o conside a ion he di e en
pe iods o ime a e ansplan and o compa e hem. Fo example, he e a e s udies
which conclude ha he quali y o li e imp o es du ing he i s six mon hs a e he
ansplan , wo sens in he in e al o 13-24 mon hs and imp o es again om 36 mon hs
a e he ansplan (Bona e al., 2000). In he same way, o he s udies conside ha
he e a e sho - e m (0-6 mon hs) and long- e m (37-120 mon hs) imp o emen s in he
quali y o li e o ansplan pa ien s, bu medium- e m (7-36 mon hs) pa ien s su e a
de e io a ion, going back o p e- ansplan le els (Pon o e al., 2001). Ne e heless,
PÉREZ-SAN-GREGORIO e al. Anxie y and dep ession in o gan ansplan 635
In J Clin Heal h Psychol, Vol. 7, Nº 3
o he s udies show ha pa ien s go h ough h ee s ages (ale , coping, and exhaus ion),
wi h: a) mo e nega i e hough s (anxious and dep essi e) and wo se physical sel -
es eem du ing he i s yea and om wo yea s a e he ansplan ; b) no signi ican
di e ences be ween hose wo pe iods; and c) di e ences be ween hose wo pe iods
when compa ed wi h he in e al o 13-24 mon hs, in which he pa ien s imp o e
(Pé ez, Ma ín, Galán, and Pé ez, 2005).
F om hese s udies, we can conclude ha a e he o gan ansplan he heal h o
he pa ien is no s abilised, bu di e en phases a e obse ed (some be e and some
wo se). All o his is conside ed in ela ion o he compa ed in e als, which di e
acco ding o he in es iga ion. Gi en he ele ance o his, he p incipal objec i e o
his ex pos ac o s udy (Mon e o and León, 2005; Ramos-Ál a ez, Valdés-Con oy, and
Ca ena, 2006) is o analyse i he anxious and dep essi e symp oms o pa ien s a y
a e he ansplan in ela ion o he h ee main s ages o he medical p ocess: a)
In ensi e Ca e Uni (ICU), wi h ecen ansplan pa ien s and admi ed in o in ensi e
ca e; b) Pos -ICU, when he pa ien is ou o in ensi e ca e bu emains in he ansplan
wa d o he hospi al; and c) Pos -hospi al, when a yea has passed a e discha ge om
a hospi al.
Me hod
Pa icipan s
We selec ed a g oup o 39 ansplan pa ien s (82.1% men and 17.9% women) who
we e assessed in h ee di e en s ages: ICU, Pos -ICU and Pos -hospi al. The a e age
age o he subjec s was o 50.56 yea s (SD = 9.62). As o he ype o o gan, he e was
a p edominance o li e (71.8%), ollowed by hea (20.25%) and kidney (7.7%). The
a e age ime spen in hospi al was 12.13 days (SD = 12.57) in ansplan ICU and 19.34
days (SD = 21.76) in he ansplan wa d. The o gan dono s we e men (59%) and
women (41%). Causes o dea h o he dono s we e as ollow: s okes (48.7%), head
inju ies (41%) and o he s (10.3%).
Ins umen s
– Psychosocial Su ey, consis ing o socio-demog aphic in o ma ion (sex, age,
social and economic s anding, e c), medical his o y (illness, ejec ions, e c.),
psychological da a (expec a ions owa ds he illness, highly-s ess ul si ua ions
expe ienced in li e, e c.) and amily in o ma ion (li ing wi h he p incipal ca e ,
ela ionship be ween pa ien and ca e , e c.).
– Hospi al Anxie y and Dep ession Scale (HAD; Zigmond and Snai h, 1983),
consis ing o 14 i ems (se en e e ing o anxie y and se en o dep ession).
Each pa ien is asked abou his/he eelings du ing he las week and he/she
mus choose among ou answe s. Values o each o he scales (Anxie y and
Dep ession) a e p o ided; in bo h cases sco es a e classi ied as: no mal (0-7
poin s), doub ul (8-10 poin s), and clinical p oblem (11 poin s o mo e). In
Spanish s udies, alpha alues ange be ween .80 and .90, we used he e sion
de eloped by Ca o and Ibáñez (1992).
636 PÉREZ-SAN-GREGORIO e al. Anxie y and dep ession in o gan ansplan
In J Clin Heal h Psychol, Vol. 7, Nº 3
P ocedu e
The g oup o ansplan pa ien s was assessed a h ee di e en s ages: ICU, Pos -
ICU, and Pos -hospi al. In each s age, he Hospi al Anxie y and Dep ession Scale (HAD)
was applied. In addi ion, in he i s s age mo e in o ma ion (socio-demog aphic, medical,
e c.) was ob ained by means o a psychosocial su ey. As gene al condi ions o he
selec ion o pa ien s in his esea ch, i was equi ed ha he e would be no e idence
o dis u bed senso y ap i udes o men al s a es ha would impede o ien a ion o he
abili y o main ain a cohe en con e sa ion. In all cases, selec ion was ca ied ou in he
o de in which he pa ien s we e admi ed o he ICU a e he ansplan . In he i s
wo s ages (ICU and pos -ICU), be o e p oceeding wi h he psychological assessmen ,
we wai ed app oxima ely a week o he pa ien s o adap o he condi ions o
hospi aliza ion.
Resul s
To compa e he anxie y and dep ession symp oms o he pa ien s in he h ee
s ages (ICU, Pos -ICU, and Pos -hospi al), we ook he ollowing s eps. Fi s , in he wo
s udied a iables ( o al anxie y sco e and o al dep ession sco e) we applied a no mali y
es (Kolmogo o -Smi no ) in each s age o he esea ch. Secondly, as all a iables
ollowed a no mal dis ibu ion, we applied a epea ed measu es analysis o a iance (F
(2, 37) = 4.69, p =.015 in anxie y; F (2, 37) = 6.16, p =.005 in dep ession). Thi dly, pai ed
- es s we e pe o med o iden i y in which g oups he e di e ences we e; in anxie y,
= 3.03, p = .004 (s ages 1 and 2), = 1.71, p = .095 (s ages 1 and 3), = –1.3, p =
.201 (s ages 2 and 3); in dep ession, = 3.2, p = .003 (s ages 1 and 2), = .66, p = .512
(s ages 1 and 3), = –2.6, p = .013 (s ages 2 and 3).
TABLE 1. Symp oms o anxie y and dep ession in di e en s ages (N = 39).
S ages: Mean (S anda d De ia ion) ANOVA S ages: -compa isonsPsychological
a iables UCI (1) Pos -UCI (2) Pos -hosp. (3) p alue (1-2) (1-3) (2-3)
Anxie y 6.87 (5.10) 4.67 (3.23) 5.44 (4.28) .015*.004** .095 .201
Dep ession 4.36 (3.08) 2.90 (2.73) 4.03 (3.63) .005** .003** .512 .013*
No e. The s onge he anxie y/dep ession s a e, he highe he sco e.
*p < .05, **p < .001.
Subsequen ly, in he g oup compa isons ha we e signi ican , we made an analysis
o i ems o iden i y he mos impo an . To do his, we ollowed wo s eps; i s ly, we
applied he Kolmogo o -Smi no es o all i ems on HAD in each s age o he s udy;
and secondly, as none o he i ems ollowed a no mal dis ibu ion, we applied non-
pa ame ic Wilcoxon es o ela ed samples.
PÉREZ-SAN-GREGORIO e al. Anxie y and dep ession in o gan ansplan 637
In J Clin Heal h Psychol, Vol. 7, Nº 3
TABLE 2. Analysis o i ems: Wilcoxon es (N = 39).
Compa ison: UCI and Pos -UCI
I ems
Mean (S anda d De ia ion)
UCI Pos -UCI Z (p alue)
Anxie y:
-‘I ha e a sensa ion o ea , as i some hing bad is going o happen’
1.05 (1.07) .41 (.54) -3.49 (.000**)
-‘My mind is ull o wo ies’
.92 (1.18) .49 (.82) -2.28 (.022*)
-‘I can si down and eel elaxed’ (+)
1.18 (.91) .79 (.73) -2.34 (.019*)
-‘I ha e a eeling o ea , as bu e lies in he s omach’
.74 (.93) .36 (.48) -2.63 (.009**)
Dep ession:
-‘I s ill enjoy he hings I liked’ (+)
.85 (1.01) .38 (.71) -2.61 (.009**)
-‘I eel as i each day I go slowe han he day be o e’
1.18 (.99) .79 (.89) -2.06 (.039*)
Compa ison: Pos -UCI and Pos -hosp.
I ems
Mean (S anda d De ia ion)
Pos -UCI Pos -hosp. Z (p alue)
Dep ession:
-‘I can laugh and see he unny side o hings’ (+)
.21 (.40) .44 (.64) -3 (.003**)
No es. The highe he sco e, he s onge he ag eemen in each sen ence, excep in (+). Only
i ems wi h s a is ically signi ican di e ences in Wilcoxon es ha e been included.
*p < .05, **p < .001
As can be seen om he analysis o he Table 1 and he Table 2, du ing he ICU
and Pos -hospi al s ages, he pa ien s we e ound in a wo se psychological s a e, since
hey showed mo e symp oms o anxie y and dep ession han in he Pos -ICU s age.
Discussion
A e he o gan ansplan , in he h ee compa ed s ages (ICU, Pos -ICU, and Pos -
hospi al) we no ice a psychological e olu ion in “U” shape, pa icula ly; hey show
mo e symp oms o anxie y and dep ession in he ICU and pos -hospi al s ages, diminishing
in he pos -ICU s age. Wi h espec o he symp oms o anxie y, he main di e ences
we e ound be ween he ICU and Pos -ICU s ages; he pa ien s el wo se in he i s
o hese s ages. A possible explana ion is ha he ICU p esen s ce ain cha ac e is ics
he pa ien s ind s ess ul: en i onmen (machines ha in ade space o he pa ien s,
a i icial ligh , mono onous noise, e c.), empo a y (na u al day and nigh hy hms a e
los , pe cep ion o dea h becomes mo e appa en due o he dea h o o he pa ien s, e c.)
and depe sonalisa ion (s a de elop no ela ionship wi h he pa ien s due o he u gency
o he si ua ion and he sho ime spen in in ensi e ca e, he only con ac is h ough
he machines, e c.) (Do -Zege , 1988). These condi ions, oge he wi h he ac ha a
638 PÉREZ-SAN-GREGORIO e al. Anxie y and dep ession in o gan ansplan
In J Clin Heal h Psychol, Vol. 7, Nº 3
his s age a pa ien is in a wo se s a e and ha he i s ew hou s a e he ansplan
a e c ucial o he success o he ansplan , make he ICU a pa icula ly s ess ul
en i onmen wi h nega i e epe cussions on he men al heal h o a pa ien . Speci ically,
symp oms o anxie y inc ease; o example, subjec s say ha hey ha e eelings o ea ,
as i some hing bad is going o happen, ha hei minds a e ‘ ull o wo ies’, ha hey
can no ‘si down and eel elaxed’ and ha hey ha e ‘ eelings o bu e lies in he
s omach’.
Wi h espec o he dep essi e symp oms, he main di e ences we e ound, on one
hand, be ween he ICU and Pos -ICU s ages and, on he o he , be ween Pos -ICU and
Pos -hospi al. Speci ically, o he h ee s ages compa ed (ICU, Pos -ICU, and Pos -
hospi al), he psychological s a e o he ansplan pa ien s imp o es in he second s age
and ge s wo se in he o he wo; be ween hese wo s ages, he e we e no signi ican
s a is ical di e ences. One possible explana ion o his psychological e olu ion is ha
he ICU, as s a ed be o e, ep esen s a highly s ess ul si ua ion o he pa ien s, and
many o hem a e no equipped o cope wi h. This makes he pa ien s dep essed; o
example, pa ien s say ha hey do no enjoy hings hey liked be o e, o ha hey eel
as i each day passes slowe han he day be o e. La e , in he Pos -ICU phase, he
psychological s a e o he pa ien s imp o es because, among o he hings, he e is a
sense o libe a ion om he dependence on he machines in he ICU, and he pa ien s’
unce ain y is inished, as much as he wai ing o an o gan as o he ansplan
ope a ion ha ollows (Moo e, Bu ows, and A di, 1997; Pon o e al., 2001). La e s ill,
in he Pos -hospi al s age, when a yea has passed a e discha ge om hospi al, he
pa ien s once again su e om low mo ale, wi h le els o dep ession simila o hose
o he ICU s age. Among o he s, he main easons o his could be he ollowing: side
e ec s o immunosupp essi e ea men , he e-inco po a ion o he wo kplace (some imes
non sui able o hei physical condi ion), he cons an ea o o gan ejec ion, and
amily con lic s a e he esump ion o p e ious oles ha o he amily membe s assumed
when pa ien had se ious heal h p oblems (Achille, Oule e, Foumie , Vachon, and
Hebe , 2006; Dew e al., 2005; Ichikawa e al., 2000; Moo e e al., 1997; Pon o e al.,
2001). This si ua ion leads, o example, o ha e di icul ies ‘ o laugh and see he unny
side o he hings’. So in he long- e m, disillusion occu s wi h he ealisa ion ha he
ansplan does no mean he eco e y o he li e hey had be o e hei illness, bu only
o e s he possibili y o li ing, and always unde medical obse a ion (Pé ez, Ma ín,
Gallego, and San ama ía, 2000).
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