Abstract
We had two goals in this study:(1) to develop a scale to assess cognitive appraisals of stressors after transplantation, (2) to examine what kind of stressors especially effect on mental health among kidney transplant recipients in Japan. The Lazarus and Folkman's stress cognitive theory was a framework of this study. The sample consisted of 154 (92 males and 62 females) adult kidney transplant recipients who were outpatients and had received their latest transplants at least 6 months ago. The questionnaire survey was conducted with some measurement scales which included our original Transplant Recipient Stress Appraisal Scale (TRSAS), and Hospital Anxiety and Depression Scale (HAD). Exploratory factor analysis revealed that TRSAS consisted of twenty three items and five factors: "Possibility of rejection and infection", "Changes in body appearance", "Restriction of job opportunities", "Ambivalence toward transplantation", "Cost of medication". Each subscale of TRSAS had high reliability (Cronbach's alpha=0.76 to 0.86). Correlation analysis indicated that all TRSAS subscales had significant correlations with anxiety and depression, but "Cost of medication" had weak correlations with them (r=0.19 both). According to this result, we examined a causal model to explore which subscale of TRSAS effected directly on mental health after kidney transplantation. Covariance structure analysis revealed that the model, including five TRSAS subscales, anxiety, depression and a latent variable "mental health," fit the data (chi-squre (4)=5.64, p=0.23, CFI=0.959, GFI=0.990, AGFI=0.887, RMSEA=0.064). In this model, (1) five TRSAS subscales accounted for 44% of the variance in mental health after kidney transplantation, (2) "Possibility of rejection and infection" and "Ambivalence toward transplantation" effected directly on mental health, (3) "Possibility of rejection and infection" effected on mental health the most. Our original scale TRSAS can be useful to identify problems each transplant recipient faces. And this is important to develop psychosocial interventions that are tailored to each recipient.
