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Greater Social Isolation and Social Constraints Prior to Hematopoietic Stem Cell Transplant Are Associated with Greater Anxiety and Depressive Symptoms

  • Special Issue: Social Isolation and Loneliness in Acute and Chronic Illness
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International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Hematopoietic stem cell transplantation (hereafter “HCT”) is a physically and psychologically difficult treatment for patients with hematological cancers. This study examined relationships among patients’ reports of pre-transplant social isolation, social constraints, and psychological distress.

Method

We used baseline data from a multisite randomized controlled trial evaluating the effects of expressive helping writing to reduce physical and emotional symptoms in HCT patients. We collected data prior to randomization and before either allogenic or autologous HCT using validated scales to assess social constraints, social isolation, anxiety, and depressive symptoms. We analyzed data using bivariate analysis and multivariate linear regression. We also explored whether social isolation mediated the effect of social constraints on both of our outcomes: anxiety and depressive symptoms.

Results

Among 259 adults recruited prior to transplant, 43.6% were women (mean age = 57.42 years, SD = 12.34 years). In multivariate analysis controlling for relevant covariates, both social isolation (β = 0.24, p < 0.001) and social constraints (β = 0.28, p < 0.001) were associated with anxiety. When both social constraints and social isolation were in the model, only greater social isolation (β = 0.79, p < 0.001) was associated with depressive symptoms. Social isolation fully mediated the association between social constraints and anxiety and depressive symptoms.

Conclusion

For patients awaiting either allogenic or autologous HCT, the negative association between social constraints and anxiety and depressive symptoms may be related, in part, to the mechanism of perceived social isolation. Interventions prior to and during HCT are needed to support patients’ psychological health and sense of social connectedness.

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Data Availability

For access to the data that supports our findings, individuals outside of the study team may submit a formal request, which will be reviewed by the executive committee. To ensure confidentiality, datasets distributed to any of these individuals will be de-identified by removing any identifying participant information.

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Acknowledgements

We wish to thank all of the study participants who contributed their time to study activities prior to a hematopoietic stem cell transplant. Thank you to Lauren Whitmore, MS, Taylor Schulte, MS, Rebecca Thompson, BS, Madison Hartstein, BS, Kendyll Poth, MS, and Joanne Assarsson, LCSW for their support of this work.

Funding

This study was funded by the National Cancer Institute of the National Institutes of Health under award number R01CA223963 (PI: Rini). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding body had no role in the study design, data collection and analysis, decision to publish, or preparation of the paper.

Author information

Authors and Affiliations

  1. Georgetown University, Washington, D.C, USA

    Layan Shahrour

  2. Cornell University, Ithaca, NY, USA

    Joseph Martinez

  3. Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C, USA

    Anthony Chicaiza

  4. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Rahma Omar, Katrin Bovbjerg, Betina Yanez & Christine Rini

  5. Department of Psychology, University of California, Los Angeles, CA, USA

    Annette L. Stanton

  6. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Heiddis Valdimarsdottir

  7. Department of Psychology, Reykjavik University, Reykjavik, Iceland

    Heiddis Valdimarsdottir

  8. Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA

    Betina Yanez & Christine Rini

  9. MedStar Georgetown University Hospital, Washington, D.C, USA

    Pashna Munshi

  10. John Theurer Cancer Center, Hackensack Meridian Health, Hackensack, NJ, USA

    Scott D. Rowley

  11. Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C, USA

    Kristi D. Graves

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  1. Layan Shahrour
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Corresponding author

Correspondence to Kristi D. Graves.

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Ethical Approval and Consent to Participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study has been approved by the Georgetown-MedStar Institutional Review Board (#2018–1306) and has received administrative approval from the review boards at all study sites. All participants completed an informed consent document to participate. Informed consent was obtained from all individual participants included in the study.

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Shahrour, L., Martinez, J., Chicaiza, A. et al. Greater Social Isolation and Social Constraints Prior to Hematopoietic Stem Cell Transplant Are Associated with Greater Anxiety and Depressive Symptoms. Int.J. Behav. Med. 31, 341–351 (2024). https://doi.org/10.1007/s12529-023-10232-8

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