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Mental Health, Nonadherence, and Healthcare Utilization in Pediatric Solid Organ Transplantation: Evidence From a

Sonnie E Mayewski1, Zhe Yang1,2, Michael O Killian1,3

  • 1College of Social Work, Florida State University, Tallahassee, Florida, USA.

Pediatric Transplantation
|March 12, 2026
PubMed

Insights

Mental health conditions like anxiety and depression are common in pediatric transplant recipients. These conditions, along with medication nonadherence, significantly increase emergency and inpatient visits, highlighting the need for integrated care.

Area of Science:

  • Pediatric Solid Organ Transplantation
  • Psychosocial Health in Chronic Illness
  • Healthcare Utilization Research

Background:

  • Pediatric solid organ transplant (SOT) recipients face unique challenges impacting their health.
  • Mental health diagnoses and medication nonadherence are potential risk factors for adverse outcomes in this population.
  • Understanding these associations is crucial for optimizing post-transplant care.

Purpose of the Study:

  • To examine the relationship between mental health diagnoses, medication nonadherence, and healthcare utilization in pediatric SOT recipients.
  • To identify predictors of nonadherence and its impact on emergency department (ED) and inpatient (IP) visits.
  • To inform interventions for improving long-term outcomes in pediatric SOT patients.

Main Methods:

  • Utilized a large, multistate electronic health record dataset of 2037 pediatric SOT recipients (ages 0-25) from 2012-2018.
  • Identified mental health conditions (depression, anxiety, PTSD, ADHD), nonadherence, and ED/IP visits using ICD-9/10-CM codes.
  • Employed logistic and negative binomial regression models, adjusting for demographic and clinical covariates.

Main Results:

  • Mental health diagnoses were prevalent: anxiety (21.6%), depression (15.3%), ADHD (13.7%), PTSD (13.1%).
  • Nonadherence (13.3%) was linked to older age, non-White race, depression, and anxiety.
  • Nonadherence independently predicted doubled rates of ED and IP visits; anxiety and PTSD also increased utilization.

Conclusions:

  • Mental health conditions and medication nonadherence are common and significantly associated with increased acute care utilization in pediatric SOT recipients.
  • Standardized psychosocial assessments and adherence interventions should be integrated into routine post-transplant care.
  • Such integration may reduce hospitalizations and enhance long-term outcomes for these vulnerable patients.
Abstract

Keywords:
healthcare utilizationmental healthnonadherencepediatricsolid organ transplantation

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