Exploring the Intersection of Mental Health Challenges and Medical Adherence in Pediatric Solid Organ Transplant Patients

Background and Purpose: More than 7,000 pediatric (aged 0 to 17 years) solid organ transplants (SOT), including lung, heart, liver, and kidney, have been performed since 2020 in the United States alone. Estimates of medical non-adherence in the pediatric chronically ill population range from around 33%-50%. Even after an organ transplant, maintaining the patient’s health requires life-long, regimented care, including medications, doctor visits, and other daily care. Medical non-adherence contributes to an increased risk of complications, hospitalizations, and death. Medical non-adherence can include missing appointments, mismanagement of medications, and not following doctor’s recommendations for medical care. Commonly cited barriers to medical adherence include cost and access, complexity of treatment regimens, and lack of social support. Pediatric SOT patients are at high risk for mental illness. Depression, anxiety, post-traumatic stress disorder (PTSD), and attention deficit hyperactivity disorder (ADHD) can impact motivation and executive function, which may extend to their adherence to medical regimens. This study aims to examine associations between diagnoses of mental illness and medical non-adherence among pediatric solid organ transplant patients.

Method: This study uses data from the OneFlorida+ Data Trust, which contains deidentified patient health record information, including diagnoses, medications, and patient demographics from healthcare providers in Florida, Georgia, and Alabama. The sample (n = 2037) is representative of the pediatric SOT population in the southeastern USA, with 49% identifying as non-White, 23% as Hispanic, and 45% as female. Logistic regression and chi-square analyses were used to assess correlations and relationships between the independent variable of medical non-adherence and the dependent variable of several mental health diagnoses.

Results: Diagnoses of each depression, PTSD, and anxiety were strongly correlated with diagnoses of medical non-adherence. Children with a history of depression diagnoses were over 3.9 times (95%CI=2.9, 5.3) as likely also to have been diagnosed with medical non-adherence, even when controlling for age (p<001, Nagelkerke r²=.15). A child with a history of an anxiety diagnosis was over 2.5 times (95%CI=1.9, 3.3) as likely to also have been noted to have concerns with medical adherence even when controlling for age (p<001, Nagelkerke r²=.13). Those with a history of PTSD diagnoses were 3.1 times as likely (95%CI=1.6, 5.8) also to have been diagnosed with medical non-adherence when controlling for age (p<001, Nagelkerke r²=.10). Perhaps surprisingly, diagnoses of ADHD were not associated with medical non-adherence in this sample, even when controlling for medication status.

Conclusions and Implications: The strong correlations between mental health disorders and medical non-adherence in pediatric SOT patients underscores the urgent need for routine mental health screenings and adherence assessments in post-transplant care. These findings advocate for a multidisciplinary approach where medical social workers play a crucial role in monitoring, educating, and supporting patients and their families. Tailored educational initiatives and psychosocial interventions should be developed to address the complex needs of these patients. A holistic care model that integrates mental health management promises to significantly enhance patient outcomes, reduce complications, and minimize hospitalizations, marking a pivotal shift in pediatric transplant medicine.