JULIO • AGOSTO • SEPTIEMBRE
DATOS DE CONTACTO
Rosana Souto Pérez
Complejo Hospitalario Universitario de Canarias. Ctra. Ofra S/N La Cuesta. San Cristóbal de La Laguna. Canary Islands (Spain). ZIP code: 38320. Phone: +34 922678795; Fax: +34 922646510.
Disclosure: The authors declare no conflicts of interest.
Evaluación de las características de la personalidad y los síndromes clínicos psiquiátricos en candidatos a donantes vivos de trasplantes renales
R.A. Souto Pérez1, Ph.D. M.R. Cejas Méndez2, B. Esteso Orduña1, J.C. Gil Hernández1, S. Poyo González1
1Psychologist Specialist in Clinical Psychology, Psychiatry Service, Complejo Hospitalario Universitario de Canarias.
2Psychiatrist, Psychiatry Service, Complejo Hospitalario Universitario de Canarias.
Background: The aim of the study was to assess personality and psychopathology of living kidney donors (LKD).
Methods: A cross-sectional design study was carried out at Complejo Hospitalario Universitario de Canarias (CHUC). 68 potential living kidney donors (PLKD) were evaluated using the Millon Clinical Multiaxial Inventory-III (MCMI-III) and psychiatric clinical interview.
Results: No candidate presented psychopathological syndrome and all the profiles were valid on the criteria set forth in the MCMI-III. The sample scored high in Narcissistic, Histrionic, Compulsive and Social Desirability scales. Women were significantly higher in Histrionic scale than men.
Conclusion: The results suggest that PLKD have a personality profile characterized by high scores on histrionics (higher in women), narcissism, compulsion and social desirability, as well as the absence of clinical psychiatric syndromes.
Key words: kidney transplants, living donors, personality, psychopathology.
Objetivo: Evaluar las características de personalidad y psicopatológicas de los donantes renales vivos.
Método: Se evaluaron 68 candidatos a donante vivo de riñón mediante el Inventario Clínico Multiaxial de Millon en su tercera edición (MCMI-III), con un diseño transversal.
Resultados: Ningún candidato presentó síndrome psicopatológico y todos los perfiles fueron válidos en base a los criterios establecidos en el MCMI-III. La muestra puntuó alto en Narcisismo, Histrionismo, Compulsión y Deseabilidad social. Las mujeres obtuvieron valores significativamente superiores en Histrionismo que los hombres.
Conclusiones: Los resultados sugieren que los potenciales donantes renales en vida presentan un perfil de personalidad caracterizado por puntuaciones altas en histrionismo (mayor en mujeres), narcisismo, compulsión y deseabilidad social, así como ausencia de síndromes clínicos psiquiátricos.
Palabras clave: donantes vivos, personalidad, psicopatología, trasplante renal.
Kidney transplant is the most efficient treatment for patients with terminal renal failure (Frade et al., 2008; Gatchalian & Leehey, 2000; Port, Wolf, Mauger, Berling, & Jiang, 1993) in relation to the quality of life (Cameron, Whiteside, Katz, & Devins, 2000). This can be carried out with graft from dead or living donor, genetically related or not, with the receiver. The living donor kidney transplantation offers better clinical results than transplants from cadaver (Pascual, Theruvath, Kawai, Tolkoff-Rubin, & Cosimi, 2002; Plaza, 2001), becoming the first choice for these patients (Guirado et al., 2008; Jendrisak et al., 2006).
Spain is the world leader for rate of renal transplantation of cadaver. However, the rate of living kidney donor transplantation, although increasing, is low compared with other European countries (Organización Nacional de Transplantes, 2012). Due to the scarcity of organs there has been an increase in the number of the studies looking at factors that may tend to the consideration and predisposition to in vivo donation, especially those persons related to the patient. During the year 2013 there were 382 living donor transplants in Spain, 12 of which were carried out in Canary Islands (Organización Nacional de Transplantes, 2013). The increase in this type of transplant is due to the low risk physical and psychological benefits to the donor (Guirado et al., 2008).
A thorough medical and psychosocial assessment of potential living kidney donors (PLKD) is required (Maldonado et al., 2012; Mori, Gallagher, & Milne, 2000; James R. Rodrigue & Guenther, 2006), the main objective of which is to ensure that the physical and mental health of the donor is optimal, identify possible contraindications and minimize the long-term risks (Frade et al., 2008; J. R. Rodrigue et al., 2014).
Studies show that living kidney donors (LKD) are motivated by self-interest, as well as the improved health of the recipient (E. Ferguson, Farrell, & Lawrence, 2008; Tong et al., 2012). Donation means an emotional reward for donors (Bolt et al., 2010). Therefore, the motivation for donating is a combination of the desire to help and the motivation of achievement of the donor (Eamonn Ferguson, France, Abraham, Ditto, & Sheeran, 2007). It has even been mentioned that for certain donors, altruism is a rationalization rather than a reason (Frade et al., 2011; Goncalez et al., 2008).
Some authors have been found that psychological and social adjustment of the LKD prior to transplantation is high (De Pasquale et al., 2013; Özçürümez et al., 2004), they also they have an optimum psychological well-being (Clemens et al., 2006). During the donation process, 39% of the LKD reported having experienced stress (Johnson et al., 1999) and some studies consider that donors are fearful of donation and worried about the impact on their health (Johnson et al., 1999; Ríos-Martínez, Huitrón-Cervantes, Rangel-Rodríguez, & Pedraza-Moctezuma, 2010). There are mixed findings about prevalence of psychological discomfort and depression in donors. While some studies indicate that donors have a lower depression prevalence than general population (Fisher, Kropp, & Fleming, 2005; Frade et al., 2008; Johnson et al., 1999; Minz et al., 2005), others have found that donation increases the levels of psychological distress and family conflicts (Reimer et al., 2006).
The amount of research on these aspects contrasts with the scarcity of literature related to the evaluation of the personality characteristics of LKD. However, a further analysis can help to ensure the optimal psychosocial adjustment after donation, as well as improve the knowledge about personality traits that influence the motivation to donate.
In this context, the aim of this study is to evaluate the characteristics of the personality and the psychopathology of PLKD in Canary Islands.
Materials and Methods
In a cross-sectional design study, 68 candidates were evaluated for living kidney donation in Complejo Hospitalario Universitario de Canarias (CHUC). All PLKD of the Canary Islands recruited between March 2010 and April 2014 were included in this study. A subject was excluded by not completing the MCMI-III.
This study was performed according to the Helsinki Declaration of 1975 and approved by the Ethics Committee of CHUC.
During the hospitalization, the protocol for assessment of the PLKD was completed. After that, psychosocial and psychopathological assessment was carried out by Psychiatric consultation liaison team. The variables were classified in demographic variables (gender, age, educational level, marital status, location of residence, type of relationship between donor and recipient), clinical variables (psychopathological syndromes, psychiatric and drug history) and dimensions of personality (Table I). Millon Clinical Multiaxial Inventory-III was used to assess the dimensions of personality (MCMI-III), the same method used by other authors in previous studies for the evaluation of PLKD (Van-der Hoftstad, Rodríguez-Marín, Martínez-Zaragoza, & Santiago-Guervós, 2013).
MCMI-III was designed to assess clinical samples in accordance with the DSM-IV-TR criteria. It can be used to identify personality disorders, psychopathological syndromes and cognitive styles (T. Millon, 1998; T. Millon & Davis, 1998), but has also been used in the general population (Caparros & Hoz, 2013; Franklin, Bowker, & Blumenthal, 2009; Larøi, DeFruyt, van Os, Aleman, & Van der Linden, 2005), and also in assessment of strategies for coping with medical illness (Cerezo, Ortiz-Tallo, & Cardenal, 2009; Øland, Jensen, Melsen, & Elklit, 2010; Wegener, Adams, & Rohe, 2012) and stressful situations. MCMI-III factor structure provides a continuum between normality and psychopathology (T. Millon, 1998).
This inventory is composed of 175 dichotomous items, true-false response. It contains 11 moderate personality disorder scales (schizoid, avoidant, depressive, dependent, histrionic, narcissistic, antisocial, aggressive-sadistic, compulsive, passive-aggressive and self-defeating), 3 severe personality disorders scales (schizotypal, borderline and paranoid), 7 clinical syndromes of moderate severity (anxiety disorder, somatoform disorder, bipolar disorder, dysthymic disorder, alcohol dependence, substance dependence and posttraumatic stress disorder) and 3 severe clinical syndromes scales (thought disorder, major depression and delusional disorder). In addition, there are also five scales used to help detect careless, confused or random responses on the test. All MCMI-III scales set 60 as the median. For personality and clinical scales, scores between 75 and 84 indicate the presence of a syndrome, while scores higher than 85 are suggestive of a disorder
In turn, psychosocial and psychopathological variables were assessed by psychiatric clinic interview.
Quantitative variables are expressed with means and standard deviations. Qualitative variables are expressed with frequencies and percentages. Comparisons between groups in quantitative variables were carried out with Mann-Whitney test. Percentages were compared with Chi square or Fisher exact tests as appropriate. All p values lower than 0.05 were considered significant. The statistical analysis was carried out with SPSS v. 17.0 (Chicago, IL).
All inventories administered were considered valid on the basis of the results of the scales of validation of the test; this means that quality of the answers enables its interpretation.
Table I shows the categories of the demographic and clinical variables of the study subjects.
None of the candidates had acute psychopathology, personality disorder or substance dependence in the evaluation. Consequently, we did not exclude any candidates for living kidney donation or the study.
Table II shows that PLKD had significant scores in Compulsive, Narcissistic, Histrionic and Social Desirability scales.
The only significant difference between the sexes is in the Histrionic scale, where women (72±11) obtained significantly higher scores (U=212,500, p<.001) compared with men (56±15).
Unlike the data found in other studies, PLKD had no significant differences by sex (Biller-Andorno, 2002; Breitkopf, 2009; Zimmerman, Donnelly, Miller, Stewart, & Albert, 2000). In our sample, 60.3 % of PKLD were women, similar to the percentage obtained by National Organization of Transplants in Spain (Organización Nacional de Transplantes, 2013) and other authors(Clemens et al., 2006).
We found that there was a predominance of married donors, with secondary studies, resident in an urban area and with kinship with the receiver, in a similar way to the data referenced in the systematic reviews (Clemens et al., 2006).
In contrast to other studies, women had significantly higher scores in histrionics (Ríos-Martínez et al., 2010). This finding may be due to cultural matters of the Canary Islands, which our study does not allow to elucidate.
Our results, in contrast with other studies, indicate the absence of psychopathology at the time of the evaluation regardless of sex and the type of relationship with the receiver. We consider that this may be due to prior selection and appraisal of living donor for kidney transplant program carried out before our psychosocial and clinical interview.
Potential donors showed high average scores on compulsive, narcissistic and histrionic scales, as well in the social desirability factor. This result may be due to several different reasons. An important aspect to consider is that high scores may reflect strength of personality, a particular personality or a clinical disorder (T. Millon, 1998; Ortiz-Tallo, Cardenal, Ferragut, & Cerezo, 2011). With this in mind, moderate scores obtained could be interpreted as healthy levels of self-esteem, sociability, and a sense of moral responsibility, as well as being classified as prototypical components of narcissistic, histrionic and compulsive constructs respectively. In non-clinical samples, high scores on these scales have been identified as indicators of health and increased of ego strength (Caparros & Hoz, 2013; T. Millon, 1998; Ortiz-Tallo et al., 2011).
The same dilemma is consistent with the high scores in social desirability in the sample, comparable to that found in a previous study (Van-der Hoftstad et al., 2013). On one hand, scores can also reflect the attitude of the PKLD in a situation of evaluation which will determine, among other factors, the ability to fulfil the requirements for donating a kidney. On the other hand, high scores in compulsion and social desirability can be suggestive of a collaboration style, sometimes minimizing symptoms of emotional distress (T. Millon, 1998). Social desirability has an inverse association with self-reporting of anxiety symptoms, as well as their severity and frequency (Olbrisch, Levenson, Sherwin, & Best, 1994), but does not influence clinical observation (Carnrike, 1997; Kuntz & Bonfiglio, 2011; Putzke et al., 2001). Furthermore, social desirability cannot be a reason to invalidate psychosocial assessment data (Kelly, Bart, & Craven, 1992). Therefore, we hypothesize that social desirability is characteristic dimension within LKD profile (Olbrisch, Benedict, Haller, & Levenson, 2001).
Finally, no control subjects were used because the tests applied here are standardized for a general population across each age group and our patients represent geographical and socioeconomic diversity, and so we determined that no further control measures were necessary.
We conclude that PLKD were characterized by the narcissistic and histrionic traits and more markedly by the compulsive and social desirability scales, as well as the absence of psychopathology. These dimensions may correspond with healthy aspects in the context of a healthy personality.
Further contributions in this field could help determine a more accurate characterization of the LKD.
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