Table 3.

Characteristics of individual studies included in the systematic review.

Study first author, year, related publications	Country	Sample size	Baseline age	Male gender	Timing of baseline assessment	Post-tx followup duration	Psychiatric risk factor measures	Risk factor-outcome relationships examineda	Methodo- logic Qualityc
Heart
Maricle, 1989,58 199159	U.S.A.	58	Adults	86.2%	Evaluation for tx	≥ 3 mo post-tx; M 2.1±1.1 y	DSM-III depressive disorder diagnoses in medical record of tx evaluation Depression and anxiety subscales, SCL-90, mean scoreb	Depression with  Mortality Depression, anxiety with  Acute rejectionb  Infectionb	1
Dew, 199960	U.S.A.	145	Aged ≥18, 46.9% < 50 y	84.1%	Across first year post-tx	2 y after baseline year	First year post-tx DSM-III-R depressive or anxiety disorders by SCID or CIDI Depression and anxiety subscales, SCL-90, score>1 SD of normative mean	Depression, anxiety with  Mortality  Acute rejection  Chronic rejection	6
Skotzko, 199938	U.S.A.	107	Adults	---	Evaluation for tx	Max 1 y post-tx	DSM-III-R depression and anxiety disorder diagnoses recorded in medical record of tx evaluation	Depression, anxiety with  Mortality  Acute rejectionb  Infectionb  Hospitalizationb	5
Zipfel, 200261	Germany	103	Adults aged ≥18	---	After listing for tx	M 4.4 y post-tx, max ~5 y	Zerssen Depression Scale, > median State subscale, STAI, score > median	Depression, anxiety with  Mortality	4
Grigioni, 200562 Sirri, 201063	Italy	95	Adults ≥ 18, M 56.0±10.1 y	83.2%	M 4.4±3.2 y post-tx, range 0.5–14.2	Max 6.2 y after baseline	Anxiety, Depression subscales, Kellner Symptom Questionnaire, score > median	Depression, anxiety with  Mortality	1
Owen, 200664	U.S.A.	108	Adults, M 53.3+12.9 y	73.1%	Evaluation for tx	M 2.7 y post-tx, range 1 day- 5.7 y	DSM depressive and anxiety disorder diagnoses recorded in medical record at tx evaluation	Depression, anxiety with  Mortality  Infectionb  Hospitalizationb	4
Havik, 200733	Norway	147	Adults, M 53.4±12.4 y, range 18–73	76.9%	M 5.6±3.9 y post-tx, range 1–16	M 6.0±0.3 after baseline	BDI, score ≥10	Depression with  Mortality	4
van de Beek, 200865	U.S.A.	313	Adults and children, median 52 y, IQR 38–59	---	Post-tx before hospital discharge	Median 5.5 y post tx, IQR 2.2–9.9, max 18 y	Diagnosis of depression recorded in medical record	Depression with  Mortality	4
Favaro, 201166	Italy	107	Adults, M 58.1±11.8 y, range 18–75	79.4%	M 3.4±1.4 y post-tx, range 1–5	M 7.8±0.5, y after baseline, range 7.2–8.9	DSM-IV post-tx current depression, PTSD diagnoses by SCID interview DSM-IV pre-tx life depression, PTSD diagnoses by SCID interview	Depression with  Acute rejectionb Depression, anxiety with  Mortality  Cancer	4
Farmer, 201367	U.S.A.	555	Adults, M 59.4 y	79%	5–10 y post-tx	M 2.5 y after baseline, max 3.5 y	Cardiac Depression Scale, mean score	Depression with Mortality	3
Liver
Singh, 199768	U.S.A.	60	Adults	---	While on wait list for tx	Max 2.7 y post-tx	BDI-1, score >10	Depression with  Mortality	3
Gedaly, 200869	U.S.A.	147	Adults, median 52 y, range 26–69	89.4%	Pre-tx	Median 3.4 y post-tx, max 11.7	History of depression recorded in pre-tx medical record	Depression with  Mortality	7
Rowley, 201037	U.S.A.	358	Adults, M 50.2±9.7 y, range 18–73	62.3%	Evaluation for tx	Median 6.2 y post-tx, range 0–13	DSM-IV-TR depressive disorder diagnoses in medical record of transplant evaluation	Depression with  Mortality	6
Corruble, 201139,2011,70 201271	France	134 152 (overlaps with 134)	For n=134: Adults, ≥18, M 50.3±10.6 y For n=152: adults, ≥18	For n=134, 63.4%	While on wait list for tx	n=134: median 3.6 y post-tx, range =0.5–5.0 n=152: max 1.5 y post-tx	For n=134: BDI, short form, mean score State subscale, STAI, mean score For n=152: BDI, short form, score ≥4	Depression with  Graft loss Depression, anxiety with  Mortality	4
DiMartini, 201131 Rogal, 201372	U.S.A.	167	Adults, M 50±8 y	84%	Across first year post-tx	9 y after baseline year	BDI-1, groups of patients with consistently low symptoms during year (scores<10), increasing symptoms, or consistently high symptoms (scores>15)	Depression with  Mortality	5
Rogal, 201136	U.S.A.	179	Adults, aged ≥18, M 52.1 y	71.5%	Evaluation for tx and while on wait list for tx	M 2.8 y post-tx, max 5.8 y	History of depression, antidepressant medication use in pre-tx medical record	Depression with  Mortality  Acute rejection  Graft loss  Infection  Hospitalization	7
Kidney
* Burke, 200840	South Africa	23	Adults, M 29.7 y	52.2%	While on wait list for tx	All at 6 mo post-tx	State subscale, STAI, mean scoreb	Anxiety with  Acute rejectionb	1
Dobbels, 200832	U.S.A.	47,899	Adults and children, 3% aged 0–17, 97% aged ≥18	60.0%	0–3 y post-tx	Max 3 yr post-tx	Medicare claim for ICD-9 diagnosis of depression not elsewhere classified recorded in United States Renal Data System database	Depression with  Mortality  Graft loss  Graft loss (death censored)	5
Novak, 201034 Molnar-Varga, 201173	Hungary	879	Adults, ≥18, M 49±13 y	58.4%	≥ 3 mo post-tx, median 4.5 y	Median 7.8 y after baseline	Center for Epidemiologic Studies Depression scale, mean score and score ≥18	Depression with  Mortality  Graft loss (death censored)	5
Corruble, 201139	France	187	Adults, ≥18 y	---	While on tx wait list	Max 1.5 y post-tx	BDI, short form, score ≥4	Depression with  Mortality  Graft loss	4
Zelle, 201274	The Netherlands	527	Adults, M 51 ±12 y	55.0%	Median 6.0 y post-tx, IQR 2.6–11.4	Median 7.0 y after baseline, IQR 6.2–7.5	Depression subscale, SCL-90, summed score ≥25	Depression with  Mortality  Graft loss (death censored)	5
Lung
* Cohen, 199875	Canada	107	Adults, ≥23 y	---	Evaluation for tx	Max ~8.5 y post-tx	BDI, mean scoreb and score >13 State subscale, STAI, mean scoreb	Depression, anxiety with  Mortalityb  Acute rejectionb  Chronic rejectionb  Infectionb	1
Vermeulen, 200876	The Netherlands	200	Adults, M 45 y, range 20–68	50.0%	While on tx wait list, assessment closest to tx (M 2.1 mo pre-tx)	Max ~14 y post-tx	ZDS, mean score State subscale, STAI, mean score	Depression, anxiety with  Mortality	5
Evon, 201077	U.S.A.	76	Adults, M 34.8 y	43.4%	Evaluation for tx	Max > 9 y post-tx	BDI, mean score	Depression with  Mortality	4
Smith, 201435	U.S.A.	201	Adults, M 49.1±13.2 y	38.8%	While on wait list for tx	M 9.2±1.5 y post-tx, range 4–12 y	BDI-II, mean score and score >13 State subscale, STAI, mean score	Depression, anxiety with  Mortality	6
Other
* Popkin, 199378 (pancreas)	U.S.A.	80	Adults, M 31.6 y	28.8%	Evaluation for tx	M 3.8 y post-tx, range 0–4.3 y	DSM-III depressive and anxiety disorder diagnoses from Diagnostic Interview Schedule conducted at tx evaluationb	Depression, anxiety with  Graft lossb	5
* Dobbels, 200979 (heart, liver, or lung recipients)	Belgium	125	Adults, ≥18 y	---	While on wait list for tx	0.5–1 yr post-tx,	Depression, anxiety subscales, Hospital Anxiety and Depression Inventory, categorized into 4 levels of severityb	Depression with  Graft lossb	3

^*Study included in systematic review but not in the meta-analysis because insufficient information was provided in order to calculate any effect size measure.

^aFor each study, only risk factor-outcomes that were examined with appropriate analyses are listed (i.e., those that did not adjust for censoring in follow-up time, or provide sufficient data to perform such calculations, were excluded). Transplant outcomes were determined in all studies from medical record or registry reviews, with the exception of Burke(40), in which the outcome was based on patient self-report.

^bAlthough appropriate analyses were performed to examine this variable, it could not be included in the meta-analysis because risk estimates and 95% CIs could not be determined from the information provided in the study.

^c1=low, 7=high; see text for description of ratings.

Abbreviations: BDI, Beck Depression Inventory; CIDI, Composite International Diagnostic Instrument; DSM, Diagnostic and Statistical Manual of Mental Disorders; ICD, International Classification of Disease; IQR, interquartile range; PTSD, post-traumatic stress disorder; SCID, Structured Clinical Interview for DSM; SCL-90, Symptom Check List 90; STAI, Spielberger State Trait Anxiety Inventory; tx, transplant; ZDS, Zung Depression Scale.