The impact of caregiver post-traumatic stress and depressive symptoms on pediatric transplant outcomes

Rachel A. Annunziato*, Margaret L. Stuber, Christina J. Supelana, Claire Dunphy, Ravinder Anand, Jinson Erinjeri, Estella M. Alonso, George V. Mazariegos, Robert S. Venick, John Bucuvalas, Eyal Shemesh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Scopus citations


PTSS as well as symptoms of depression have been reported in children who experience a serious medical adversity as well as their caretakers. The adverse effects of PTSS, when experienced by the patients, on medical outcomes have been clearly documented. However, the impact of those symptoms, if any, when experienced by the caretakers on child outcomes has not been investigated prospectively. We evaluated whether caregiver PTSS and depression symptoms predict adherence to medications and medical outcomes in a prospective multisite study. Four hundred children participated in MALT. Caretaker PTSS were assessed by the IES and depressive symptoms by CES-D. During 2 years of follow-up, the MLVI was used to determine adherence. Centrally read, biopsy-confirmed organ rejection was the primary medical outcome. IES scores were not associated with either adherence or rejection outcomes. In contrast, there were significant correlations between CES-D (depression) scores and lower adherence, r =.13, P <.001, and a trend toward higher scores on the CES-D among those whose children had experienced rejection, 12.4 (SD = 10.9) versus 9.1 (SD = 8.6), P =.077. Caregivers' PTSS were not a risk factor for poor child outcomes in this cohort, whereas depression symptoms were associated with non-adherence and possibly increased rates of rejection. Further study can validate if caregivers' depression as opposed to PTSS confers greater risk and should be a focus during the clinical care of medically ill children.

Original languageEnglish (US)
Article numbere13642
JournalPediatric transplantation
Issue number1
StatePublished - Feb 1 2020


  • adherence
  • depression
  • medication level variability index
  • post-traumatic stress symptoms
  • transplant

ASJC Scopus subject areas

  • Transplantation
  • Pediatrics, Perinatology, and Child Health


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