High Rates of Post-Transplant Depressive Symptoms Identified Using the Ces-D

Although all lung transplant candidates undergo a comprehensive, pre-transplant psychological assessment, there is little research examining depressive symptoms assessed early after transplant. In our experience, the patient’s medical condition and clinical presentation are the primary focus of early postoperative care, while psychological changes often receive less attention. This study sought to characterize the presence of depressive symptoms early after transplantation using serial assessments of a clinically validated screening test. Lung transplant recipients were screened for depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CES-D) between 4/2010 and 12/2014. Re-transplant and multi-organ transplant recipients were excluded from the analysis. Patients completed the CES-D at the start of post-transplant physical therapy (within a week of transplant hospital discharge) and at the end of post-transplant physical therapy (prior to relocation home). The CES-D includes 20 item encompassing 6 dimensions of depressive symptoms (e.g. depressed affect, somatic symptoms, etc.). A score of ≥ 16 is suggestive of clinically elevated depressive symptoms. All recipients with elevated depressive symptoms scores were referred to psychology. One hundred and four lung transplant recipients completed the initial post-transplant CES-D, of which 35 (34%) recipients met criteria for high depressive symptoms. Among patients with follow up CES-D available after physical therapy (n = 94), 13 (14%) had elevated depressive symptoms with 7 having prior elevated depressive symptoms and 6 recipients who were not initially considered to have elevated depressive symptoms, now exhibited elevated depressive symptoms following physical therapy. Twenty-one (22%) exhibited a decrease in CES-D score to <16. This study demonstrates that there is a high rate of depressive symptoms early after lung transplant. Elevated depressive symptoms persisted in a minority of recipients while others subsequently reported elevated depressive symptoms post-transplant despite engagement in a structured exercise program. Transplant providers may benefit from greater monitoring of post-transplant depressive symptoms, and may benefit from the adoption of universal screening practices.