Symptoms of Depression and Anxiety in Adolescents with Sickle Cell Disease: The Role of Intrapersonal Characteristics and Stress Processing Variables

Abstract

Sickle cell disease (SCD) complications place patients at risk for poor psychosocial adaptation, including depression and anxiety symptoms. This study aimed to test a mediator model based on the Risk and Resistance model to explore the role of intrapersonal characteristics and stress processing variables in psychosocial functioning. Participants were 44 adolescents with SCD, 15 healthy siblings, and 43 primary caregivers, recruited from an East Coast comprehensive sickle cell center. The participants completed paper and pencil measures of resilience factors (attributional style, hope, coping) and internalizing symptoms (depression, anxiety). Internalizing symptoms among adolescents with SCD and healthy siblings did not differ and were within non-clinical ranges. Self-esteem of adolescents with SCD was correlated with less depression and anxiety and sense of inadequacy was associated with poorer functioning. There were no findings to support the role of coping in psychosocial adjustment. Although the mediation hypothesis was not supported, findings highlighted the resilience of this sample of adolescents with SCD. Determining how these resilience factors protect adolescents with SCD may aid in the development of psychosocial interventions. In particular, interventions should focus on improving intrapersonal skills and coping with stress and investigate ways to tailor these interventions to African-American populations.

Psychiatric Disorders in a Sample of Saudi Arabian Adolescents with Sickle Cell Disease

“…Studies of psychiatric disorders among adolescents with SCD yielded conflicting results (Iloeje 1991;Adedoyin 1992;Armstong et al 1993;Thompson et al 1999;Simon et al 2009). The results of these studies were varied due to the heterogeneity of cohorting among the studied patients as well as the tool used for psychiatric assessment.…”

“…On the contrary, some authors found no difference in psychiatric morbidity between a group with sickle-cell disease and controls. For example, Simon et al (2009) suggested that internalizing symptoms among adolescent with SCD and healthy siblings do not differ and were within non-clinical range on a self-reported questionnaire. Also Cepeda et al (1997), through employing a standardized clinical interview based on DSM-III-R criteria reported that adolescents with SCD do not have a greater risk for clinically significant psychiatric disorders than the same-race outpatient clinic controls.…”

“…Finally, it has been generally assumed that those with the most severe SCD are at the greatest risk for psychological problems (Kell et al 1998;Simon et al 2009). The average fetal hemoglobin level which helps as modifier of SCD severity in the Saudi patients ranged between 22 and 26.8%.…”

“…Other studies failed to show significant levels of anxiety and depression in children with SCD as compared with non-affected peers or those with other chronic illnesses (Kumar et al 1976;Alao and Cooley 2001;Simon et al 2009). …”

“…Thompson et al (1999) reported that 10-30% of adolescents with chronic illnesses reported at least one anxiety symptoms, however, very few studies indicated the specific level of anxiety for adolescents with SCD (Simon et al 2009). …”