Depressive Disorders Among Adults with Hemophilia a

INTRODUCTION

Depression can impact quality of life, functioning, and treatment adherence. However, depression in persons with hemophilia A (PwHA) is not uniformly examined nationwide. We report on depression and treatment-related hemophilia symptoms and utilization in a sample from six geographically representative U.S. Hemophilia Treatment Centers (HTCs).

METHODS

Hematology Utilization Group Studies part Va (HUGS Va, 2005-2007) was an observational study that collected data on sociodemographics and 12-Item Short Form Health Survey (SF-12) via patient survey, and clinical characteristics via medical chart review for adults (≥18 years old) with hemophilia A. Depressive disorders were assessed by the SF-12 mental component score (MCS), a validated population-based measure including depressive disorders. MCS≤45 has been identified as a depressive symptom threshold suggestive of a disorder. MCS≤36 indicate more severe psychological symptomatology and/or impairment. Demographic and clinical characteristic associations with depression were assessed using Chi-square tests.

RESULTS

The analysis included 147 adults with mean age 33.0±12.5 years old, 64% with severe hemophilia. Using the criteria of MCS≤45, 27.9% of sample had depressive disorder, and 10.2% had more severe depression at MCS≤36, higher than the 9.0% prevalence of current depression in the general U.S. population studied by CDC's Behavioral Risk Factor Surveillance System survey data (2006 and 2008). Compared with individuals with no depressive disorder, those with depression were less likely to complete their high school education (51.2% vs. 75.2%, P<0.01), had lower income<$40,000 (65.0% vs. 51%, P=0.20), were unemployed (56.1% vs. 31.1%, P<0.01), and lower rates of private health insurance coverage (41.5% vs. 61.0%, P=0.06). Those with depression were less likely to be treated prophylactically (22.0% vs. 31.1%, P=0.27), more likely to have joint pain or range of motion limitation (70.7% vs. 60.4%, P=0.24), and more likely to report barriers to hemophilia care (26.8% vs. 15.1%, P=0.1). The proportion of depressive disorders was not significantly different among levels of hemophilic severity (25.0% in mild/moderate hemophilia and 29.5% in severe, P=0.56).

CONCLUSIONS This sample of PwHA reported higher rates of potentially depressive disorders than the general USA population. Lower educational levels, joint problems, and barriers to accessing care may be high-risk factors for depressive disorders.