Psychological adaptation and symptom distress in bone marrow transplant recipients

This prospective study was designed to measure changes in the psychological status, self-esteem, dependence on other people, physical symptom distress and coping during isolation for bone marrow transplantation (BMT). A sample of 26 BMT patients was assessed at four different points in time. Results indicated that high psychological morbidity was present the day before the transplant, which remained elevated throughout hospitalisation and even a month after discharge. Main distressing symptoms included changes in bowel patterns, fatigue, insomnia, poor appetite and poor concentration. Tension-anxiety and depression showed a non-significant decrease throughout hospitalisation, but anger-hostility and fatigue were increased, especially in the last assessment about a month after discharge from hospital. Activity levels declined over time. Dependence on others and self-esteem have shown no significant changes over time, although pre-transplant assessment showed low self-esteem and a high degree of dependence on others. Main coping mechanisms during isolation identified in the study were hope, directing attention, maintaining control over the situation and acceptance. Psychological disturbance during isolation had a 'carry-over' effect even a month after discharge from hospital. Higher symptom distress was associated with higher mood disturbance. Different types of isolation during BMT were not associated with differential amounts of psychomorbidity. Finally, patients who received professional psychological support during BMT demonstrated significantly lower mood disturbance compared with patients who did not receive psychological support.