Acute Pain and Depressive Symptoms: Independent Predictors of Insomnia Symptoms among Adults with Sickle Cell Disease

Abstract

Background No studies to-date have systematically investigated insomnia symptoms among adults with sickle cell disease (SCD). The purpose of this study was to 1) describe the prevalence of insomnia symptoms and 2) identify bio-psychosocial predictors in community-dwelling adults with Sickle Cell Disease. Methods Cross-sectional analysis of baseline data from 263 African-American adults with SCD (aged 18 years or older). Measures included the Insomnia Severity Index (ISI), Center for Epidemiologic Studies in Depression scale, Urban Life Stress Scale, Brief Pain Inventory, and a chronic pain item. SCD genotype was extracted from the medical record. Results A slight majority (55%) of the sample reported clinically significant insomnia symptomatology (ISI ≥10), which suggests that insomnia symptoms are prevalent among community-dwelling African-American adults with SCD. While insomnia symptoms were associated with a number of bio-psychosocial characteristics, depressive symptoms and acute pain were the only independent predictors. Conclusion Given the high number of participants reporting clinically significant insomnia symptoms, nurses should screen for insomnia symptoms and to explore interventions to promote better sleep among adults with SCD with an emphasis on recommending treatment for pain and depression. In addition, current pain and depression interventions in this population could add insomnia measures and assess the effect of the intervention on insomnia symptomatology as a secondary outcome.

Indirect Economic Burden of Sickle Cell Disease

“…38 They also may have disturbed sleep or sleep-disordered breathing. [39][40][41][42][43][44] Fatigue may be severe, with severe anemia, and correlates substantially not only with pain but with sleep quality, anxiety, depression, and stress 45 and neurocognitive function and decreased quality of life. 46 Poor interpersonal relationships at work have been reported to be a larger contributor to unemployment than physical health in individuals with SCD.…”

Prevalence and correlates of major depression among Nigerian adults with sickle cell disease

“…30 Pain and depression have also been shown to increase insomnia in adults with SCD in another study. 10 It is therefore plausible that the elimination of pain in an effective manner would ameliorate depressive symptomatology. We did observe that SCD patients with depression had a significantly greater number of days on analgesia/month compared with their non-depressed counterpart.…”

“…4,5 Among the few reports exploring psychiatric co-morbidity in adults with SCD, depression is commonly reported, with rates ranging between 2% and 57%. 6–12 Other studies have reported that anxiety disorders, 13–15 alcohol abuse, psychosis, 4 suicidal ideation, 12 and sleep disturbances 16 are also common. Psychiatric co-morbidity in SCD is associated with increased hospital visits, 9 pain crises, 10 and poor quality of life.…”

Prevalence of clinical manifestations suggestive of depression in patients with sickle cell disease: a review

“…Three studies had a maximum score 10,23,24 . And, two had scores equal to 11 25,26 . These two articles did not make clear the confounding factors and, consequently, the strategies to deal with them.…”