Depression, Anxiety and Pain Medication Utilization in Adult Patients with Sickle Cell Disease

Abstract

Introduction:Sickle cell disease (SCD) is a debilitating chronic genetic disorder that affects approximately 100,000 people in the United States and millions of people worldwide. Chronically ill patients are at risk of developing psychological disorders such as depression or anxiety that can lead to deteriorating function and increased pain medication utilization. Prior studies have revealed that patients with SCD who have depression or anxiety also have poorer pain control and a decreased quality of life. The purpose of this study was to examine the prevalence of depression and anxiety in a cohort of patients at a sickle cell center located in a metropolitan city. Moreover, we investigated the association between depression, anxiety and utilization of pain medication or healthcare.

Methods:We conducted an analytic cross-sectional study on SCD patients to determine the prevalence of depression.

Descriptive analysis was performed with frequency distributions. Univariate logistic regression was conducted to investigate the relationship between depression and anxiety and pain medication utilization and psychiatric referral.

Results:87 patients who completed questionnaires and have available information from electronic medical record were included in the analysis. Overall 35.6% of patients (N=31) from our cohort had a diagnosis of depression and 23% (N=20) were diagnosed with anxiety. 64.5% of depressed patients (N=20) reported taking at least 1 psychotropic agent. 100% of SCD patients with depression or anxiety used opioid pain medication. Number of pain crisis among SCD patients with depression was significantly different from that among SCD patients with no depression (Odds Ratio 3.043, 95% CI: 1.303-7.110).

Healthcare utilization was also found to be positively associated with patients with a diagnosis of depression. Patients with depression were almost 16 times more likely to have psychiatric health care utilization than patients without depression (Odds Ratio 15.597, 95% CI: 5.028-48.387). However, the number of hospital admissions for pain crisis among patients with depression was not statistically different from those without depression (Odds Ratio 1.714, 95% CI: 0.752-3.909).

Conclusion:Overall 40% of adult patients with SCD from our cohort had depression and/or anxiety. All of these patients (100%) were on chronic opioid medications. The presence of depression among SCD patients was significantly related to more pain crises and psychiatry health care utilization. We recommend that sickle cell clinics and sickle cell centers should provide necessary resources, so that behavioral health teams will be readily available on-site to serve this chronically ill population of patients. This would likely lead to better pain management and less utilization of health care resources.