<p>Interrelationship between depression, anxiety, pain, and treatment adherence in hemophilia: results from a US cross-sectional survey</p>

Abstract

PurposeDepression, 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 methodsAdults 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.ResultsAmong 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).ConclusionDepression 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.

The relationship between chronic pain and psychosocial aspects in patients with haemophilic arthropathy. A cross‐sectional study

“…Although depression is underdiagnosed in patients with haemophilia, it is associated with anxiety, pain and decreased adherence to treatment. 15 Identifying the patient's behavioural, sociological and psychosocial aspects is important for establishing the best strategy for pain management in patients. 16 The aim of this study is to evaluate the relationship between the perceived intensity of chronic, usual and maximum pain, and joint damage, kinesiophobia, catastrophism, anxiety and the perception of quality of life in adult patients with haemophilic arthropathy.…”

“…Pain, depression and anxiety have complex, two‐way interrelationships. Although depression is underdiagnosed in patients with haemophilia, it is associated with anxiety, pain and decreased adherence to treatment 15 . Identifying the patient's behavioural, sociological and psychosocial aspects is important for establishing the best strategy for pain management in patients 16 …”

Foot health-related quality of life in hemophiliacs: A case-control study

“…For this reason haemophilic subjects can be also affected in their general health especially in aspects related to HQoL on their foot disorders, as the case of plantar fasciitis [11] or psychosocial aspects [12,13]. The main purpose of this study was to compare both foot and general health-related quality of life between haemophiliac and healthy subjects.…”

Evidence of a disability paradox in patient‐reported outcomes in haemophilia

“…Haemophilia is a lifelong genetic disorder associated with significant clinical burden driven by haemarthrosis, joint damage and pain, with subsequent negative impact on patients’ mental health, daily functioning and overall quality of life (QoL) 1,2 . The substantial reductions in morbidity and mortality afforded by modern therapeutic advances have elevated the aims of haemophilia treatment to realize a functional cure and to bring health equity to patients with this persistent, lifelong condition 3 .…”