Sickle Cell Disease, More Than Just Pain: The Mediating Role of Psychological Symptoms

A Systemic Review of the Psychosocial Aspects of Chronic Pain in Youth With Sickle Cell Disease

OBJECTIVES

The psychosocial aspects of chronic pain among youth with sickle cell are poorly described and may be better understood within a biopsychosocial model of chronic pain as applied to youth living with sickle cell disease.

DESIGN

A systematic literature review was performed to synthesize the psychosocial factors contributing to chronic pain in this population. Criteria for study inclusion were primary quantitative research studies focused on psychosocial aspects of chronic pain among youth with sickle cell disease.

DATA SOURCES

PubMed, CINAHL, PsychINFO, and Scopus were searched for relevant articles.

REVIEW/ANALYSIS METHODS

Articles selected for full-text review were appraised for quality using the Joanna Briggs Institute Quality Appraisal Tools. Thirteen articles were included.

RESULTS

Depression, anxiety, pain catastrophizing, pain coping, executive functioning, and functional impairment were prevalent in youth living with sickle cell disease and chronic pain. Research gaps included the influence of stigma, injustice, peer interactions, and school and work on chronic pain.

CONCLUSIONS

The biopsychosocial model of chronic sickle cell disease-related pain for youth was developed and modified based on the results of this systematic review to remind clinicians of the various factors to consider in clinical practice and spur additional research in this field.

Daily Loneliness Affects Quality of Life in Sickle Cell Disease

BACKGROUND

Loneliness is related to psychosomatic challenges in chronic illnesses; however, very little research focuses on loneliness in sickle cell disease (SCD), the most common genetic blood disorder. This study used a daily diary method to illustrate how loneliness and quality of life co-occur in the day-to-day lives of people living with SCD.

METHOD

Seventy-nine adults living with SCD (63 women; mean age = 31.76 years) completed daily electronic surveys comprised of a brief loneliness scale and a single-item measure of quality of life. Participants completed each survey once per day for up to 42 consecutive days. We evaluated the effects of daily changes in loneliness on next-day quality of life through multilevel regression models.

RESULTS

Central findings indicated that there were significant between-person (b = - .993, p < .001, 95% CI = - 1.26, - .725) and within-person (b = - .202, p < .005, 95% CI = .327, - .089) effects. Specifically, participants who reported higher mean levels of loneliness also reported lower quality of life. Further, days on which participants reported higher loneliness were followed by days on which they reported lower quality of life.

CONCLUSIONS

These results may be the first to suggest a connection between loneliness and psychological outcomes in adults living with SCD. Daily fluctuations in loneliness appear to be associated with decrements in next-day quality of life. Future studies should elucidate the clinical relevance and broader health-related implications of these findings.

Poverty and the wellbeing of children with sickle cell disease: The mediating role of parenting stress

BACKGROUND

Living in poverty in the midst of caring for a child with sickle cell disease (SCD) presents with challenges that may be overwhelming for caregivers. Prior research has shown a relationship between poverty and poor outcomes in children; however, no study has investigated the mediating role of parenting stress on health-related quality of life (HRQOL) for such children.

PROCEDURE

A total of 150 patients, ages 8-17 years and their parents, were enrolled and completed measures of parenting stress (caregivers) and HRQOL (patients). Caregivers also completed a demographic information questionnaire, which was used to determine poverty status. The Sobel test was used to analyze the association between poverty and HRQOL by way of parenting stress.

RESULTS

The series of linear regression results show poverty was a significant predictor for decreased HRQOL (B = -7.01, p = .05) among pediatric patients with SCD. Moreover, the regression coefficient measuring the indirect effect of the model measuring the mediating role of parenting stress was statistically significant (B = -1.05, p = .05).

CONCLUSION

The current study found an association between poverty status and HRQOL scores by way of parenting stress. Findings highlight the need for appropriate resource allocation to caregivers in addition to pediatric patients living with SCD.

Psychiatric comorbidities in adults with sickle cell disease: A narrative review

Although descriptions of quality of life and patient reports of mood in sickle cell disease (SCD) have become more common in the literature, less is known about psychiatric illness prevalence, presentation, and treatment, particularly for adults. We provide a narrative review of what is known about common and debilitating psychiatric conditions such as depression, anxiety, and cognitive impairment, specifically for adults with SCD. We discuss the limitations of the current evidence, make provisional recommendations, and identify opportunities for research and improved care.

Psychological symptom screening in an adult sickle cell disease clinic and predictors of treatment follow up

Absence of formal and systematic screening for mood and anxiety disorders among patients with sickle cell disease (SCD) can result in under-recognized psychological problems. This study examined the prevalence of psychological symptoms using a systematic screening process. Patients with SCD completed four self-report screening tools for measurement of depressive and anxiety symptoms, self-efficacy, and pain. The goal was to detect patients with psychological symptoms and identify predictors of follow-up treatment attendance. A total of 336 adult patients (57% female, mean age 33 years) completed validated screening instruments for major depressive disorder and generalized anxiety disorder. Patients recommended for mental health follow-up included higher proportions of women. Patients who accepted the mental health follow up had higher levels of education compared to groups that did not accept nor attend the follow-up appointment. Overall, 34% of patients who endorsed elevated distress scores and were referred for mental health care attended the follow-up appointment. Findings suggest patients with SCD and elevated psychological distress are likely to use mental health treatment resources, which notes this program's success in identifying needs and responding to them. However, further research is needed to understand ways to engage this population in mental health care.