Previous sickle cell disease (SCD) studies found that patients who have anxiety and depression have worse pain control compared to patients without these mental health problems. The purpose of this study was to assess SCD patient demographics, education level, literacy, employment and pain characteristics related to anxiety and depression.
A descriptive study was conducted with a convenience sample of 100 SCD patients at an academic medical system hematology clinic. A research assistant administered a structured interview which included demographic questions (age, gender, type of SCD, employment, marital status, education), amount of opioid pain medication needed in a 24-hour period for chronic pain, and the PROMIS (Patient-Reported Outcomes Measurement Information System) Pain Intensity, Pain Interference, Depression and Anxiety surveys. Cognitive ability was screened for using the Callahan 6-Item Screener. Literacy was assessed using the REALM-SF.
PROMIS anxiety and depression surveys consist of eight questions each which are scored on a 5 point Likert scale ranging from 1 (never) to 5 (always). The tests are scored on a T-score metric and normed to the adult U.S. population with a mean of 50 and a standard deviation of 10. Interpretation of scores: Mild range (T scores 55-60), moderate (T scores 60-70), and severe (T scores>70).
Analysis of variance (ANOVA) was conducted to investigate the relationship between anxiety, depression, pain intensity and interference to age, gender, type of SCD, education, employment and marital status.
Patient age ranged from 19 to 66 years with a mean of 33 years. All patients were African Americans, 52% were female. Despite the fact that over half were at least high school graduates (37% were high school graduates while an additional 14% graduated from college), none were reading or above a 9th grade level.
Table 1 shows percentage of patients falling under mild, moderate and severe of the measured item compared to general US population as well as mean raw score with SD (standard deviation) and corresponding T scores. Of note, mean (SD) daily pain medication dose with this population was 108 mg (87mg) of morphine.
Table 2 shows the p value of t-test or ANOVA for the comparison between factors for those variables where appropriate. As shown in table, only employment status was related to anxiety and depression.
On spearman correlation, statistically significant positive correlation was found between pain intensity with pain interference (0.46) and depression (0.30). Also statistically significant positive correlation was found between pain interference with pain intensity (0.46), depression (0.39) and anxiety (0.46)
Overall, adult patient with SCD have more pain interference compared to general US population, even while they are on chronic opiate medications. The presence of anxiety and depression positively predicts worse pain intensity and pain interference in adult patients with SCD. The patient related factors like age, gender, education, type of SCD and marital status are not related to anxiety, depression, and pain intensity or pain interference.
No relevant conflicts of interest to declare.
Asterisk with author names denotes non-ASH members.