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

Abstract

SummaryAlthough 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.

Psychiatry referral and appointment attendance in a clinic for young adults with sickle cell disease

“…In prior studies of adults with SCD, 20%-40% screen positive for depression, significant anxiety, or both. 1 In our study, there was at least a 17% prevalence of mood disorders in young adults entering adult SCD care. In our clinic population, the prevalence may be higher as some subjects who were not evaluated probably had mood disorders.…”

“…Stroke and chronic pain are indications for chronic transfusion, and both are associated with depression. 1 Most psychiatry referrals were made during the initial hematologist visit. Subjects with less than a high school education were less likely to be referred at initial visit, though not less likely to be referred overall.…”

“…Among adults with sickle cell disease (SCD), depressive symptoms are associated with high hospitalization rates, greater reported pain, and more opioid prescriptions. 1 Young adults with SCD may be uniquely vulnerable, because they enter the adult healthcare system during a dynamic life stage, emerging adulthood (ages 18 and 25 years). Transfer into the adult healthcare system at this age also coincides with worsening SCD and reduced use of and access to routine SCD care.…”

How young adults with sickle cell disease define “being a good patient” in the adult healthcare system

“…30 Executive dysfunction can interfere with decisionmaking, planning, and completing tasks. 31 Neurocognitive testing is not yet systematically performed before transfer to adult care. This testing may help establish realistic expectations, inform behavioral intervention and support, and help adult SCD programs direct limited resources toward those identified as needing extra support.…”