Prevalence of Anxiety and Depression In Transfusion-Independent Thalassemia Intermedia Compared to Regularly-Transfused Patients with Thalassemia Major

Despite favorable effect on survival, the burden of chronic transfusion and iron chelation therapy in patients with thalassemia major (TM), alongside clinical complications of the disease, still pose a negative impact on patients' quality of life (QOL) and mental health. In patients with thalassemia intermedia (TI), the milder nature of the disease and transfusion-independence in many cases, imply better psychosocial adaptation. However, the unbalanced, chronic underlying pathophysiology of the disease still allows for several serious clinical complications to manifest, which may have a negative impact on patients' QOL and mental health. We herein evaluate the prevalence of anxiety and depression in TI as compared to TM patients.

This was a cross-sectional, questionnaire-based study on TI (transfusion- and iron chelation-independent) and TM (regularly transfused and iron chelated) patients attending the Chronic Care Center, Hazmieh, Lebanon. Institutional review board approval was obtained and all participating patients signed an informed consent. A total of 81 patients agreed to participate in the study (33 TI and 48 TM). The State Trait Anxiety Inventory (STAI) questionnaire was used to assess anxiety level of patients. The questionnaire was previously translated, adapted and validated on the Lebanese population. The Beck Depression Inventory (BDI) questionnaire was used to assess depression level of patients. It was also previously translated and administered to a Lebanese population. Data on patient demographics, socioeconomic status, and disease complications (cardiovascular, gastrointestinal, and endocrine) were collected.

Patients with TI and TM were comparable in demographics, socioeconomic status, and number of disease complications (Table 1 ). TI patients had a significantly higher State Anxiety score than TM patients (40.9 ± 12.2 vs. 34.9 ± 21.1; P=0.031) and a higher yet not statistically significant Trait Anxiety score (42.1 ± 11.1 vs. 38.0 ± 11.5; P=0.117). Mean scores of both patient groups fell within norms reported for a healthy Lebanese sample. A higher, yet not statistically significant, proportion of TI patients suffered some form of depression compared to TM (TI, 45.5% [21.2% mild, 9.1% mild-moderate, 12.1% moderate-severe, 3.0% severe] vs. TM, 29.2% [18.8% mild, 4.2% mild-moderate, 6.2% moderate-severe, 0.0% severe]; P=0.133).

Advances in medical therapy allowed TM patients to lead almost normal lives. However, the burden of disease treatment and complications still present significant challenge and may affect mental health, notably, a high rate of depression. Transfusion-independent patients with TI show a similar rate of depressive symptoms that could be partially attributed to the high number of complications associated with the disease.

No relevant conflicts of interest to declare.