Common mental disorders in hematopoietic stem cell transplant patients: a scoping review

Almeida, Ana Clara Paiva de; Azevedo, Valéria Dantas de; Alves, Tássia Regine de Morais; Santos, Viviane Euzébia Pereira; Silva, Glauber Weder dos Santos; Azevedo, Isabelle Campos de

doi:10.1590/0034-7167-2022-0581

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REVIEW • Rev. Bras. Enferm. 77 (1) • 2024 • https://doi.org/10.1590/0034-7167-2022-0581 copy

Common mental disorders in hematopoietic stem cell transplant patients: a scoping review

Trastornos mentales comunes en pacientes con trasplante de células madre hematopoyéticas: revisión del alcance

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to map common recurrent mental disorders in patients undergoing hematopoietic stem cell transplantation.

Methods:

this is a scoping review carried out in January 2022 in electronic databases and repositories of dissertations and thesis. Studies that answered the research question, met the objective of the study and were available in full electronically, in any language, were included.

Results:

the sample consisted of 28 studies, 14 of which were published in the United States of America. The common mental disorders found were depressive, anxiety, post-traumatic stress and mood disorders. Twenty symptoms were mentioned, among the most prevalent are fatigue and sleep disorders/insomnia.

Conclusions:

the difficulty and importance of carrying out the differential diagnosis of these disorders were highlighted, since their symptoms can be confused with other health problems and have a strong potential to interfere with patients’ evolution.

Descriptors:
Hematopoietic Stem Cells Transplantation; Bone Marrow Transplantation; Mental Disorders; Mental Health; Review

ID^* * ID - Identification;	Authors/year	Country	Design/ number of patients	Interventions	Outcomes	CMD diagnoses^† † CMD - Common Mental Disorder;	Symptoms of CMD ^† † CMD - Common Mental Disorder;	Level of evidence
A1 ^‡	Harder H, Cornelissen JJ, Gool ARV, Duivenvoorden HJ, Eijkenboom WMH, Bent MJ (13)/2002	United States of America	Prospective cohort/40	Mini Mental State Examination, Karnofsky Performance Scale, The Groninger Intelligence Test, The National Adult Reading Test, Word Fluency Test, California Verbal Learning Test, Rey Complex Figure Test, Digit Span of the Wechsler Adult Intelligence Scale, Trail Making Test, Stroop Color Word Test, Finger Tapping Task, Reaction Time Task, Questionnaires of QOL and Mood States.	The mental status screening test revealed no abnormalities (89.8%). Mild to moderate cognitive impairment was found, and quality of life among transplant recipients in the long term (up to 10 years) still presents a wide range of persistent complaints.	-	Fatigue; sleep disorders (unspecified); memory changes; changes in attention; concentration changes	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A2 ^‡	Fann JR, Alfano CM, Roth-Roemer S, Katon WJ, Syrjala KL(14)/2007	United States of America	Prospective cohort/90	Patients completed a battery assessing quality of life, distress and neuropsychological functioning. Delirium was assessed three times a week using the Delirium Rating Scale and the Memorial Delirium Assessment Scale from seven days before transplantation until 30 days after transplantation.	Patients with malignancy who experienced delirium during myeloablative transplantation had impaired neurocognitive abilities and persistent distress 80 days after transplantation.	Anxiety disorder; depressive disorder	Fatigue; anguish	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A3 ^‡	Bevans MF, Mitchell SA, Marden S(15)/2008	United States of America	Prospective longitudinal/76	The occurrence of symptoms, distress and clusters was determined based on the 11 symptoms of the Symptom Distress Scale.	Allogeneic HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; patients experience multiple symptoms and high discomfort on days 0 and 30 after transplant conditioning. On day 100, the experience is characterized by few symptoms and a low level of distress.	-	Fatigue; insomnia; concern; changes in appetite	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A4 ^‡	Chang G, Meadows ME, Orav EJ, Antin JH(16)/2009	England	Prospective cohort/106	Application of General Social Survey prestige scales, Shipley Institute of Living Scale, Estimate a Full-Scale Intelligence Quotient Medical Outcomes Study 36-Item Short Form, Brief Profile of Mood State and neuropsychological tests.	Time and diagnosis can be important factors in the assessment of neurocognitive changes, with improvement in CMD symptoms^† † CMD - Common Mental Disorder; over 18 months.	-	Memory changes; confusion	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A5 ^‡	Wingard JR, Huang IC, Sobocinski KA, Andrykowski MA, Cella D, Rizzo JD, et al.(17)/2010	United States of America	Prospective cohort/655	Self-reported physical health was measured using the Physical Component Summary score and the Medical Outcomes Study 36-Item Short Form Health Survey.	Clinical and psychosocial factors improved among young transplant recipients, with good financial income, who had no treatment complications and fewer comorbidities over six years post-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; .	Anxiety disorder	-	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A6 ^‡	Basinski JR, Alfano CM, Katon WJ, Syrjala KL, Fann JR(18)/2010	Multicenter	Prospective cohort/52	Patients completed an assessment of distress, quality of life, and subjective neuropsychological functioning before receiving their first HSCT ^II II HSCT - Hematopoietic Stem Cell Transplant; as well as at six months and one year after transplantation.	The group that presented delirium had more fatigue and distress during treatment, and worse neuropsychological functioning at 6 months post-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; compared to patients who did not have an episode of delirium.	Anxiety disorder; depressive disorder	Fatigue; anguish; confusion	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A7 ^‡	Sun CL, Francisco L, Baker KS, Weisdorf DJ, Forman SJ, Bhatia S(10)/2011	United States of America	Prospective cohort/1065	Psychological health status was assessed using the Brief Symptom Inventory-18.	The proportion of survivors reporting post-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; somatic distress decreased significantly over time (over 10 years). In contrast, the proportion of survivors with anxiety or depression remained unchanged during this period.	Anxiety disorder; depressive disorder	Somatic suffering	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A8 ^‡	Tecchio C, Bonetto C, Bertani M, Cristofalo D, Lasalvia A, Nichele I, et al.(19)/2013	Italy	Prospective longitudinal/ 107	Anxiety and depression were assessed by the State-Trait Anxiety Inventory and Self-Rating Depression Scale.	One-tenth of patients suffered from anxiety and depressive symptoms on admission. Although the percentage of depressed patients more than doubled after 2 weeks of pre -HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; isolation, that of anxious patients did not change significantly over time.	Anxiety disorder; depressive disorder	-	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A9 ^‡	Hoodin F, Zhao L, Carey J, Levine JE, Kitko C(20)/2013	United States of America	Case-control/101	The experimental group completed the Patient Health Questionnaire briefly, focused on diagnosis to assess depressive disorders, anxiety, substance abuse, and problems in occupational or interpersonal functioning before meeting with their doctor and discussing these symptoms. The control group had access after the consultation.	The prevalence of depression in the 5-year period after HSCT ^II II HSCT - Hematopoietic Stem Cell Transplant; was significant, and anxiety (14%) or suicidal ideation (8%) did not differ between the 2 groups. Patients in the experimental group were significantly more likely to discuss psychological symptoms than the control group.	Anxiety disorder; mood disorders (unspecified)	Suicidal ideation	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A10 ^‡	Crooks M, Seropian S, Bai M, Mcorkle R(21)/2014	England	Prospective cohort/ 80	Participants were given a demographic questionnaire, an emotional stress relief thermometer and a list of problems. The forms were shared with different team members and after this step, the thermometer and the list of problems were applied again at discharge, and three and six months after discharge from HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; .	Patients had an average level of emotional distress of 4.35 in the conversation about transplantation before admission; 4.42, at high; 3.54, at his three-month clinic visit; and 1.75, at six months. On average, patients’ responses revealed low to moderate levels of psychosocial distress over time, and their distress decreased at 3 and 6 months post-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; .	-	Fatigue; sleep disorders (unspecified); sadness; nervousness; concern; changes in appetite; fear	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A11 ^‡	Masule MS, Arbabi M, Ghaeli P, Hadjibabaie M, Torkamandi H(22)/2014	Will	Prospective longitudinal/21	Anxiety questionnaire was used and Depression Scale and Wechsler memory Scale within 72 hours after admission and one month after HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; .	It was observed that anxiety was significantly lower post-transplant compared to the pre -transplant level. However, no significant difference was found between preand post-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; depression.	Anxiety disorder; depressive disorder; post-traumatic stress disorder	-	IV ^¶ ¶ IV - Evidence from literature review, cross-sectional study, systematic review, narrative study or retrospective study; ** D - Dissertation.
A12 ^‡	Pillay B, Lee SJ, Katona L, Burney S, Avery S(23)/2014	Australia	Retrospective cohort/122	A series of measures were completed as part of the psychological assessment of patients undergoing transplantation. They were applied the Mental Adjustment to Cancer Scale, the Brief Symptom Inventory-18 and World Health Organization Quality of Life-BREF.	In this study, 12% and 14% of the sample presented significant levels of depressive and anxious symptoms, half reported impaired physical quality of life and 40% cited poor psychological and social quality of life.	Depressive disorders; anxiety disorders	Concern; helplessness	IV ^¶ ¶ IV - Evidence from literature review, cross-sectional study, systematic review, narrative study or retrospective study; ** D - Dissertation.
A13 ^‡	Artherholt SB, Hong F, Berry DL, Fann JR(24)/2014	United States of America	Prospective cohort/192	Participants were assessed pre -transplant and again 6 to 7 weeks later. Measures assessed included Symptom Distress Scale, the EORTC core quality of life questionnaire for quality of life, a single-item pain intensity question and the Patient Health Questionnaire-9 for measuring depression.	Although few patients (6%) met criteria for moderate or high depression before transplant, nearly a third (31%) met criteria for moderate or high depression when assessed six to seven weeks after transplant.	Depressive disorder	-	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A14 ^‡	Rocha V, Kalinke LP, Felix JVC, Mantovani MF, Maftum MA, Guimarães PRB(25)/2015	Brazil	Analytical longitudinal/25	Data collection occurred through sociodemographic and clinical data questionnaires, the Quality of Life Questionnaire-C30 (version 3.0, Portuguese, Brazil) and the Functional Assessment Cancer Treatment-Bone Marrow Transplantation (version 4.0, Portuguese, Brazil).	They demonstrated a statistically significant worsening in global quality of life, functional scales, physical, social and family function, personal performance and additional concerns in the baseline, pancytopenia and prehospital discharge periods.	-	Fatigue; insomnia	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
D1 ^**	Proença SFFS(26)/2015	Brazil	Analytical longitudinal/25	Questionnaires were applied to adult cancer patients 100 days after the HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; : sociodemographic and clinical data version 2.0; EORTC core quality of life questionnaire, validated for Brazil to assess general quality of life; and Functional Assessment of Cancer Therapy Bone Marrow Transplantation version 4.0, Portuguese, validated for Brazil, specific for assessing quality of life in transplantation.	It was possible to observe that, at the end of hospitalization, patients have a quality of life with greater impairment in physical function, personal performance, symptoms (fatigue, loss of appetite, nausea and vomiting), social and family well-being, well-being functional, additional concerns, and 100 days after transplantation, patients recover baseline values, with the exception of functional well-being.	-	Fatigue; insomnia	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
D2 ^**	Marques ACB(5)/2016	Brazil	Analytical longitudinal/45	Data were collected using the following instruments: sociodemographic and clinical data; updating sociodemographic and clinical data; global quality of life; EORTC core quality of life questionnaire; and Functional Assessment of Cancer Therapy Bone Marrow Transplantation^II II HSCT - Hematopoietic Stem Cell Transplant; version 4.0.	The results express changes in patients’ quality of life, which translate into symptoms that go beyond physical complications, as they reveal emotional and social weaknesses present during treatment and that have disabling potential and negatively influence these patients, especially in the early stages of treatment. treatment. On the other hand, the analysis of results also showed that surviving patients consider their quality of life to be satisfactory after one year of transplantation.	-	Fatigue; insomnia	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A15 ^‡	El- Jawahri A, Vandusen H, Traeger L, Fishbein JN, Keenan T, Gallagher ER et al.(27)/2016	United States of America	Prospective longitudinal/90	Questionnaires such as the Functional Assessment of Cancer Therapy-Bone Marrow Transplantation, Posttraumatic Stress Disorder Checklist, Hospital Anxiety and Depression Scale and the Patient Health Questionnaire were applied.	There was a decline in quality of life and an increase in depressive symptoms six months after hospitalization for HSCT ^II II HSCT - Hematopoietic Stem Cell Transplant;	Anxiety disorder; depressive disorder	-	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A16 ^‡	Ghazikhanian SE, Dorfman CS, Somers TJ, O’Sullivan ML, Fisher HM, Edmond SN, et al.(8)/2017	United States of America	Prospective longitudinal/138	Preand post-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; questionnaires were applied who assessed sleep and cognitive problems as well as commonly concomitant symptoms such as depressive symptoms, fatigue and pain.	Sleep problems are associated with and may contribute to cognitive problems in patients over the six months post-HSCT ^II II HSCT - Hematopoietic Stem Cell Transplant;	Depressive disorders	Fatigue; sleep disorders (unspecified)	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A17 ^‡	Kroemeke A, Kwissa Gajewska Z, Sobczyk-Kruszelnicka M(28)/2018	Poland	Cross-sectional/290	Center for Epidemiological Studies Depression Scale, Hospital Anxiety and Depression Scale, quality of life, EORTC core quality of life questionnaire, New General Self-Efficacy Scale and transplant assessment were assessed in participants.	Four latent well-being profiles were identified: good functioning (51%, greater well-being in all aspects); dysfunctional (10%, weaker functioning in all aspects); 2 profiles with moderate and high (5.6%) or low (33.4%) quality of life; and anxiety and depressive symptoms in the pre-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; period.	Depressive disorders; anxiety disorder	-	IV ^¶ ¶ IV - Evidence from literature review, cross-sectional study, systematic review, narrative study or retrospective study; ** D - Dissertation.
A18 ^‡	Penalba V, Asvat Y, Deshields TL, Vanderlan JR, Chol N(29)/2018	United States of America	Cross-sectional/351	Questionnaires were applied to assess distress, anxiety, depression and quality of life using validated instruments, such as the Functional Assessment of Cancer Therapy-General.	The subset of patients who presented for pre -transplant psychosocial assessment subsequently utilized psychotherapy services and these reported low levels of distress, depression or anxiety.	Anxiety disorder; depressive disorder; post-traumatic stress disorder	-	IV ^¶ ¶ IV - Evidence from literature review, cross-sectional study, systematic review, narrative study or retrospective study; ** D - Dissertation.
A19 ^‡	El- Jawahri A, Pidala J, Khera N, Wood WA, Arora M, Carpenter PA, et al.(30)/2018	Multicenter	Prospective cohort/482	It was examined the relationship between self-reported symptoms of depression or anxiety (measured by the Lee Symptom Scale) and patients’ quality of life (Functional Assessment of Cancer Therapy-General and the Physical Component Scale of the 36-item Short-Form Health Survey), functioning physical (measured by the human activity profile), functional status (measured by the 2-minute walk test) and overall survival.	The findings suggest that patients with self-reported symptoms of depression or anxiety present substantial impairments in their physical functioning, functional status and general quality of life in the post-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; period and that they developed graft-versus-host disease.	Anxiety disorder; depressive disorder	-	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A20 ^‡	Esser P, Kuba K, Ernst J, Mehnert-Theuerkauf A(31)/2019	Germany	Cross-sectional/300	The following instruments were applied: Structured Clinical Interview, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, Depressive and Anxious Symptomatology, General Distress (Distress Thermometer), Fear of Progression, Comorbidity, Adjustment Disorder Symptomatology, Posttraumatic Stress Disorder Symptomatology, Posttraumatic Growth Inventory, Experiential Avoidance.	The prevalence of stress-related disorders and the level of distress among patients with hematological cancer in different treatment settings was verified.	Anxiety disorder; depressive disorder; post-traumatic stress disorder	Difficulty in adapting	IV ^¶ ¶ IV - Evidence from literature review, cross-sectional study, systematic review, narrative study or retrospective study; ** D - Dissertation.
A21 ^‡	Nelson AM, Juckett MB, Coe CL, Costanzo ES(32)/2019	United States of America	Prospective longitudinal/332	Participants completed measures of illness perception (beliefs about the consequences and course of cancer, personal and treatment control over cancer, and understanding of cancer itself) before transplantation. Health practices (diet, physical activity and alcohol use) and mental health (depression, anxiety and psychological well-being) were assessed before transplantation and at 1, 3, 6 and 12 months after transplantation.	Mixed-effects linear regression models revealed that HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; recipients who perceived the consequences of their cancer as more severe experienced more depression and anxiety, less well-being, and ate a healthier diet, but were less physically active during the year after transplant.	Anxiety disorder; depressive disorder	-	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A22 ^‡	Erden S, Kuşkonmaz BB, Çetinkaya DU, Ünal F, Özsungur B(33)/2019	Turkey	Cross-sectional/30	All children were interviewed using the Kiddie Schedule for Affective Disorders and Schizophrenia, Children’s Depression Inventory, State-Trait Anxiety Inventory for Children, State-Trait Anxiety Inventory, and Rosenberg Self-Esteem Scale.	During the transplant process, children showed a higher prevalence of depression, anxiety disorder and attention deficit/hyperactivity disorder, and non-donor siblings showed a higher prevalence of depressive disorder, anxiety and attention deficit/hyperactivity disorder compared to society in general.	Anxiety disorder; depressive disorder	Changes in self-esteem	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A23 ^‡	Azevedo IC, Ferreira Júnior MA, Flores VGT, Gonçalves EAP, Frota OP, Cardoso MP, et al.(9)/2019	Brazil	Cross-sectional/43	Medical records of 43 patients who underwent HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; were assessed.	Among 43 patients with psychological disorders, 51.16% were female. It was observed that patients presented psychological distress from the hematological neoplasia diagnosis until the end of treatment.	Anxiety disorder; depressive disorder	-	^II II HSCT - Hematopoietic Stem Cell Transplant; I ^§
A24 ^‡	Liang J, Lee SJ, Storer BE, Shaw BE, Chow EJ, Flowers ME, et al.(34)/2019	United States of America	Cross-sectional/1024	Patients completed self-report measures of sociodemographic information. Clinical variables were captured in the transplant database.	Patients or caregivers who had post-traumatic stress disorder reported significantly greater distress related to uncertainty, family tension, medical demands, finances, identity, and health burden in the post-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; period (7 to 10 years).	Anxiety disorder; depressive disorder; post-traumatic stress disorder	Sleep disorders (unspecified)	IV ^¶ ¶ IV - Evidence from literature review, cross-sectional study, systematic review, narrative study or retrospective study; ** D - Dissertation.
A25 ^‡	Amonoo HL, Brown LA, Scheu CF, Harnedy LE, Pirl WF, El- Jawahri A, et al.(35)/2020	United States of America	Qualitative study/21	Interviews explored symptoms of psychological distress in hospital and during the first 100 days after transplant, along with the perceived impact of these symptoms on their recovery.	Of the negative emotional experiences reported, feeling trapped, fear, guilt, discouragement and helplessness were frequently expressed in the post-HSCT^II II HSCT - Hematopoietic Stem Cell Transplant; period.	Depressive disorder	Fear; guilt; discouragement	IV ^¶ ¶ IV - Evidence from literature review, cross-sectional study, systematic review, narrative study or retrospective study; ** D - Dissertation.
A26 ^‡	Lemieux C, Ahmad I, Bambace NM, Bernard L, Cohen S, Delisle JS, et al.(36)/2020	Canada	Retrospective cohort/47	The EQ-5D instruments were used to assess mobility, self-care, usual activities, pain/discomfort and anxiety/depression, and the Functional Assessment of Cancer Therapy-Bone Marrow Transplant was used to assess physical, social/family, emotional well-being and functional and transplant-specific concerns.	The results of the EQ-5D and Functional Assessment of Cancer Therapy-Bone Marrow Transplant demonstrate that advanced age at transplantation is not a factor that impacts quality of life in post-HSCT ^II II HSCT - Hematopoietic Stem Cell Transplant; patients for lymphoma treatment.	Anxiety disorder; depressive disorder; post-traumatic stress disorder	-	IV ^¶ ¶ IV - Evidence from literature review, cross-sectional study, systematic review, narrative study or retrospective study; ** D - Dissertation.

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[1] Corresponding author: Isabelle Campos de Azevedo, E-mail: isabellebr2511@gmail.com