Psychological distress and associated factors among kidney transplant recipients and living kidney donors during COVID-19.

Journal Article (Journal Article)


The coronavirus disease 2019 (COVID-19) pandemic has caused significant psychological distress globally. Our study assessed the prevalence of psychological distress and associated factors during COVID-19 pandemic among kidney transplant recipients and kidney donors.


A cross-sectional survey of 497 participants (325 recipients and 172 donors) was conducted from 1st May to 30th June 2020 in Singapore. The survey questionnaire assessed knowledge levels of COVID-19, socio-demographic data, health status, psychosocial impact of COVID-19, and precautionary behaviors during the pandemic. Psychological distress was defined as having anxiety, depression, or stress measured by the validated Depression, Anxiety and Stress Scale-21. Linear regression analyses were used to assess factors associated with higher psychological distress.


The prevalence of psychological distress was 14.3% (95% confidence interval: 11.5-17.6%) in the overall population; it was 12.8% (9.79-16.6%) in recipients and 13.4% (9.08-19.6%) in donors with no significant difference (P = 0.67). Younger age (21-49 vs. ≥50 years), unmarried status, non-Singapore citizen, worse health conditions, and worrying about physical and mental health were associated with higher psychological distress. Malays (versus Chinese), taking precautionary measures (hand sanitization), and receiving enough information about COVID-19 were associated with lower psychological distress. No interactions were observed between recipients and donors.


At least one in ten recipients and donors suffer from psychological distress during COVID-19 pandemic. Focused health education to younger adults, unmarried individuals, non-Singapore citizens, and those with poor health status could potentially prevent psychological distress in recipients and donors.

Full Text

Duke Authors

Cited Authors

  • Thangaraju, S; Wang, Y; Kee, T; Tee, PS; Lu, YM; Yong, JH; Ho, QY; Liew, IT; Foo, F; Kwan, N; Ng, E; He, X; Lee, C; Baey, S; Leong, J; Tan, J; Shirore, RM; Jafar, TH

Published Date

  • February 2022

Published In

Volume / Issue

  • 23 / 1

Start / End Page

  • 80 -

PubMed ID

  • 35209868

Pubmed Central ID

  • PMC8867454

Electronic International Standard Serial Number (EISSN)

  • 1471-2369

International Standard Serial Number (ISSN)

  • 1471-2369

Digital Object Identifier (DOI)

  • 10.1186/s12882-022-02698-7


  • eng