Patient Preference and Adherence (Sep 2019)
Interrelationship between depression, anxiety, pain, and treatment adherence in hemophilia: results from a US cross-sectional survey
Abstract
Michelle L Witkop,1 Angela Lambing,2 Cynthia D Nichols,3 James E Munn,4 Terry L Anderson,5 Bartholomew J Tortella5 1Nursing Department, Northern Regional Bleeding Disorders Center, Munson Medical Center, Traverse City, MI, USA; 2Nursing Department, Henry Ford Hemophilia and Thrombosis Treatment Center, Detroit, MI, USA; 3Nursing Department, Munson Medical Center, Traverse City, MI, USA; 4Hemophilia & Coagulation Disorders Program, University of Michigan Hemophilia Treatment Center, Ann Arbor, MI, USA; 5Medical Affairs, Pfizer Inc, Collegeville, PA, USACorrespondence: Michelle L WitkopNational Hemophilia Foundation, 7 Penn Plaza, Suite 1204, New York, NY 10001, USATel +1 347 541 2963Fax +1 212 328 3777Email [email protected]: Depression, anxiety, pain, and treatment adherence have reciprocal effects not characterized extensively in hemophilia. This study explored the relationships between depression, anxiety, chronic pain, and treatment adherence in adults with hemophilia.Patients and methods: Adults with self-reported hemophilia A or B completed the cross-sectional IMPACT QoL II survey. Depression (9-item Patient Health Questionnaire [PHQ-9]), anxiety (7-item Generalized Anxiety Disorder scale [GAD-7]), chronic pain (Faces Pain Scale–Revised [FPS-R]), social support (Duke UNC Functional Social Support questionnaire), level of pain control, clotting factor treatment adherence (VERITAS-Pro or -PRN), and previous depression/anxiety were analyzed.Results: Among 200 participants (male, 77.3%; female, 22.8%), 54% had PHQ-9 and 52% had GAD-7 scores indicating moderate to severe depression or anxiety without diagnosis of either disorder. Participants with PHQ-9 scores ≥10 (moderate to severe depression) were more likely to have lower treatment adherence than those with PHQ-9 scores <10 (P<0.05). Participants with PHQ-9 or GAD-7 scores ≥10 were more likely to report uncontrolled pain and less social support versus PHQ-9 or GAD-7 scores <10 (χ2 P<0.05). Significant correlations were found between PHQ-9 and GAD-7 (P<0.0001), PHQ-9 and FPS-R (P=0.0004), PHQ-9 and VERITAS (P=0.01), GAD-7 and FPS-R (P=0.02), and GAD-7 and VERITAS (P=0.001).Conclusion: Depression and anxiety are underdiagnosed in hemophilia. Depression is associated with anxiety, pain, and lower treatment adherence. While treatment providers play an important role in diagnosis, social workers may play a pivotal role in depression and anxiety screening. This study highlights the importance of regular screening and treatment for these disorders.Keywords: blood coagulation disorders, depressive disorder, mental disorders, comorbidity, patient compliance, social support
