Table 3. Potential risk factors for posttraumatic stress disorder symptoms following solid organ transplantation.

Study (N)	Measure of association	Potential risk factor	Outcome: posttraumatic stress symptoms/disorder
Stukas et al. 1999 [18] (N = 300) a	Hierarchical logistic regressionb	Group (caregiver) Female Family psychiatric history Personal psychiatric history Low friend support Low family cohesion Low mastery Low family cohesion × personal psychiatric history Low family cohesion × family psychiatric history	OR: 1.60, n.s. OR: 3.36, P < 0.01 OR: 1.18, n.s. OR: 3.04, P < 0.01 OR: 2.24, P < 0.05 OR: 1.37, n.s. OR: 1.60, n.s. P < 0.05 P < 0.05
	Hierarchical linear regressionb	(j) Group (caregiver) (k) Gender (l) Age (m) Income (n) Personal psychiatric history (o) Low friend support (p) Low family cohesion (q) Low mastery (r) High avoidant coping	(j) β: 0.02, n.s. (k) β: 0.07, n.s. (l) β: -0.26, P < 0.05 (m) β: -0.23, n.s. (n) β: 0.89, P < 0.001 (o) β: 0.31, P < 0.05 (p) β: 0.22, n.s. (q) β: 0.41, P < 0.01 (r) β: 0.11, n.s.
Dew et al. 2001b [20] (N = 63)	χ2 test	VAD as a bridge to heart transplantation	n.s.
Dew et al. 2012 [21] (N = 239)	Cox proportional hazards regression	Female History of depression or anxiety disorder SF-36 PF at 2 months post-transplant Chronic dyspnea at 2 months post-transplant Poor social support from family caregiver Low support from religious faith High support seeking/expression of emotions High avoidance coping	HR: 1.53 (95%CI: 0.76, 3.11) HR: 2.61 (95%CI: 1.21, 5.68) HR: 0.99 (95%CI: 0.98, 1.01) HR: 0.82 (95%CI: 0.69, 0.97) HR: 1.12 (95%CI: 0.57, 2.20) HR: 0.69 (95%CI: 0.32, 1.49) HR:0.89 (95%CI: 0.43, 1.83) HR: 1.61(95%CI: 0.80, 3.20)
Fukunishi et al. 2002 [22] (N = 95)	χ2 test	Pre-transplant alexithymia	n.s.
Fukunishi et al. 2001 [23] (N = 275)	χ2 test	Hospital LOS, liver or kidney function, allograft rejection, major complications	n.s.
Possemato et al. 2009 [24] (N = 63)	Spearman's correlation	Age Gender Education Ethnicity # of prior traumas	R = -0.18, n.s. R = -0.13, n.s. R = 0.27, P ≤ 0.05 R = 0.06, n.s. R = 0.39, P ≤ 0.01
Cohen et al. 2014 [27] (N = 25)	Spearman's correlation	Higher resilience	R = -0.45, P = 0.02
Jin et al. 2012 [26] (N = 241)	Stepwise multiple linear regression	Age, gender, marital status, income, employment status, etiology of liver failure, donor type, time since transplant, immunosuppressive agent MELD score Complications Educational status	n.s. β = 0.24, P = 0.01 β = 4.96, P = 0.009 β = -4.78, P = 0.01
Guimaro et al. 2011 [27] (N = 24)	Mann-Whitney U	Time from liver transplant (< 5 months vs. > 5 months)	24 vs. 15 IES-R points, P = 0.09
Possemato et al. 2010 [28] (N = 48)	Repeated measures analysis of covariance	Medical fact writing vs. Expressive writing	36 vs. 32 PCL-C points, P = 0.14 10 vs. 8 PCL-C intrusive symptom points, n.s. 13 vs. 12 PCL-C avoidant symptom points, n.s. 12 vs. 10 PCL-C arousal symptom points, P = 0.09
Baranyi et al. 2013 [29] (N = 126)	Mann-Whitney U, χ 2, or Fisher's exact test	Time since transplant Pre-transplant psychiatric diagnosis Pre-transplant benzodiazepine use (any vs. none) Post-transplant benzodiazepine use (any vs. none) Pre-transplant alcohol abuse (any vs. none) Post-transplant alcohol abuse (any vs. none) Gender Years of education/vocational training Employment status Age Type of transplant Post-operative medical complications Re-transplantation	Comparisons: PTSD vs. No PTSD 29 vs. 24 months, P = 0.14 44% vs. 11%, P = 0.001 16% vs. 3%, P = 0.02 21% vs. 11%, P = 0.02 16% vs. 20%, P = 1.00 5% vs. 5%, P = 1.00 P = 0.59 P = 0.85 P = 0.09 49 vs. 53 years old, P = 0.04 Liver (30%) vs. Lung (9%) vs. Heart (6%), P = 0.003 P = 0.46 16% vs. 4%, P = 0.07
	Multiple linear regression	(n) Age (o) Gender (p) Pre-transplant psychiatric diagnosis (q) Re-transplantation (r) Pre-transplant benzodiazepine use (s) Liver transplant (t) Lung transplant (u) Post-operative medical complications (v) Time since transplant (w) Post-transplant SF-36 PCS (x) Post-transplant SF-36 MCS (y) Post-transplant occupation/work satisfaction (z) Post-transplant benzodiazepine use	(n) β = 0.07, P = 0.44 (o) β = 0.10, P = 0.32 (p) β = 3.07, P = 0.04 (q) β = 4.84, P = 0.02 (r) β = 0.67, P = 0.50 (s) β = 0.10, P = 0.33 (t) β = -0.05, P = 0.62 (u) β = 0.12, P = 0.18 (v) β = 0.15, P = 0.11 (w) β = -0.33, P < 0.001 (x) β = -0.53, P < 0.001 (y) β = -0.20, P = 0.004 (z) β = 0.07, P = 0.28
Gries et al. 2013 [30] (N = 210)	Bivariate linear regression	Younger age Lower income Unmarried Prior traumatic event Lower post-transplant FVC or FEV1 Acute cellular rejection Bronchiolitis obliterans syndrome Time since transplant Idiopathic pulmonary fibrosis vs. COPD	P < 0.001 P = 0.001 P = 0.001 P = 0.003 P < 0.001 P < 0.001 P = 0.01 P = 0.63 P = 0.05
	Multiple linear regressionc	(j) Age (k) Female (l) Pre-Transplant Pulmonary Diagnosis (COPD is reference): (11) Idiopathic pulmonaryfibrosis (12) Cystic fibrosis (13) Pulmonary arterialhypertension (14) Other(m) Private insurance (n) Prior traumatic event (o) Acute rejection (p) Bronchiolitis obliterans syndrome	(j) β = 0.35, P < 0.001c (k) β = -0.12, P = 0.10 (11) β = 0.02, P = 0.84 (12) β = 0.09, P = 0.32 (13) β = 0.005, P = 0.94 (14) β = 0.03, P = 0.65 (m) β = 0.23, P < 0.001c (n) β = -0.25, P < 0.001c (o) β = -0.10, P = 0.10 (p) β = -0.18, P = 0.005c
Favaro et al. 2011 [33] (N = 107)	χ2 test	Time on transplant wait list, acute rejection, immunosuppressant type, 1-year rejection score, pre-transplant smoking, education, marital status, gender, age, prior traumatic experience Low social support Prior major depression	(a) n.s. (b1) Avoidant PTSD symptoms: P < 0.006 (b2) Sub-threshold PTSD: P < 0.01 (b3) Full PTSD: P < 0.04 (c) Full PTSD: P < 0.05, OR: 4.4 (95%CI: 1.0, 20.4)
Rothenhäusler et al. 2002 [34] (N = 75)	Kruskal-Wallis one way analysis or χ2 test	Female Age (median) Disabled Married Months since transplant (median) Days on transplant wait list (median) Median ICU LOS (days) Alcoholic liver disease Infectious hepatitis PBC/PSC Hepatic malignancy Miscellaneous liver disease Acute liver failure History of retransplantation History of recurrence of HBV/HCV In-hospital delirium Post-operative GI bleeding Post-operative infections Acute rejection Cardiovascular complications Acute renal failure ARDS Number of in-ICU complications (median) Post-transplant cognition (median SKT score) Post-transplant depression (median HAM-D score) Social support (median Social Support Scale score)	Comparisons: Full PTSD vs. Sub-threshold PTSD vs. No PTSD 0% vs. 54% vs. 43%, P = 0.16 44 vs. 51 vs. 55, P = 0.20 50% vs.46% vs. 33%, P = 0.55 50% vs. 77% vs. 81%, P = 0.29 42 vs. 63 vs. 43, P = 0.27 8 vs. 11 vs. 28, P = 0.03 13 vs. 14 vs. 9, P = 0.01 0% vs. 38% vs. 33%, P = 0.30 75% vs. 8% vs. 22%, P = 0.30 0% vs. 8% vs. 14%, P = 0.30 0% vs. 8% vs. 7%, P = 0.30 25% vs. 38% vs. 24%, P = 0.30 0% vs. 31% vs. 15%, P = 0.27 0% vs. 44% vs. 9%, P = 0.06 100% vs. 22% vs. 26%, P = 0.32 25% vs. 61% vs. 29%, P = 0.08 50% vs.31% vs. 28%, P = 0.63 50% vs. 77% vs. 50%, P = 0.21 50% vs. 92% vs. 53%, P = 0.03 50% vs. 46% vs. 29%, P = 0.39 25% vs. 69% vs. 43%, P = 0.16 25% vs. 8% vs. 5%, P = 0.30 3 vs. 4 vs. 3, P = 0.04 5 vs. 3 vs. 1, P < 0.01 22 vs. 7 vs. 2, P < 0.001 33 vs. 63 vs. 71, P < 0.01
Bunzel et al. 2007 [35] (N = 38)	Mann-Whitney U or Wilcoxon or Fisher's exact test	Spouse with PTSD vs. Spouse without PTSD VAD device type, age, cardiac diagnosis, pulsatile vs. non-pulsatile mechanical circulatory assist device	(a1) 10 vs. 5 IES-R avoidance symptom points, P = 0.008 (a2) 12 vs. 4 IES-R hyper-arousal symptom points, P = 0.001 (b) n.s.
Bunzel et al. 2005 [37] (N = 41)	Wilcoxon test	Pulsatile vs. non-pulsatile mechanical circulatory assist device	n.s.

Abbreviations (in alphabetical order): ARDS = acute respiratory distress syndrome; β = linear regression coefficient in multivariable model; CI = confidence interval; COPD = chronic obstructive pulmonary disease; FEV1 = forced expiratory volume in 1 second; FVC = forced vital capacity; HAM-D = Hamilton Rating Scale for Depression; HR = hazard ratio; HBV = hepatitis B virus; HCV = hepatitis C virus; ICU = intensive care unit; IES-R = Impact of Events Scale-Revised; LOS = length of stay; MELD = Model for End-Stage Liver Disease; n.s. = not significant; OR = odds ratio; PCL-C = PTSD Checklist-Civilian version; PTSD = posttraumatic stress disorder; PBC = primary biliary sclerosis; PSC = primary sclerosing cholangitis; SF-36 MCS = Short-Form 36 Mental Component Summary; SF-36 PCS = Short Form-36 Physical Component Summary; SF-36 PF = Short-Form-36 Physical Functioning score; SKT = Short Cognitive Performance Test; VAD = ventricular assist device.

^aThe analyses examining potential risk factors for post-transplant PTSD included both transplant recipients and their caregivers.

^bRegression models were adjusted for recipient vs. caregiver status.

^cIn the multivariable linear regression models, the PCL-C outcome underwent inverse transformation. Therefore, a negative β coefficient corresponds to greater PTSD symptoms, while a positive β coefficient corresponds to fewer PTSD symptoms.