Systematic Review: Pain and Emotional Functioning in Pediatric Sickle Cell Disease

Abstract

The objective of this systematic review was to assess the relationship between pain (frequency/intensity/duration, impairment, coping) and emotional functioning in pediatric Sickle Cell Disease, and evaluate the state of the literature. Studies were included if they met each of the following criteria: (a) primarily pediatric sample of youth or young adults up to age 21 years with SCD, (b) examined emotional functioning including anxiety and/or depressive and/or internalizing symptoms, and/or affect, (c) examined pain intensity/frequency/duration and/or pain-related impairment and/or pain coping as it relates to emotional functioning, as defined above. Using the established guidelines for systematic reviews, we searched PsycINFO, PubMED, and CINAHL databases for studies published through June 2018. Screening resulted in 33 studies meeting inclusion criteria. Study data were extracted and evaluated for scientific merit, resulting in four studies being removed. 29 studies were included in the final synthesis. Studies provide strongest evidence of a relationship between increased pain frequency and higher depressive and anxiety symptoms. There are moderate-to-strong associations between pain-related impairment and depressive symptoms, and small-to-strong associations between pain-related impairment and anxiety. When examining pain-coping strategies, maladaptive cognitive strategies show the strongest association with emotional functioning. There is a need for more adequately powered, prospective studies based on theoretical frameworks in order to advance our understanding of the relationship between pain and emotional functioning in pediatric SCD.

<p>Depression and Anxiety as Moderators of the Pain-Social Functioning Relationship in Youth with Sickle Cell Disease</p>

“…These data are consistent with previous studies that indicated depression rates in youth with SCD ranging from 4% to 75%, and anxiety ranging from 8% to 41%. 15 However, despite the majority of our sample reporting subclinical levels of depression and anxiety symptoms, results still indicated that these symptoms influenced the relationship between pain and social functioning. Inconsistent with our hypothesis, depressive symptoms did not modify the relationship between pain and social functioning.…”

“…A systematic review found strong evidence for a relationship between high pain frequency and more symptoms of depression and anxiety in youth with SCD, and findings also indicated that more symptoms of depression and anxiety were related to high pain-related impairment. 15 In addition, a study of adolescents with SCD found that high levels of stress and negative mood were associated with increased school absences and decreased participation in everyday social and home activities (Gil et al 2003), When youth who experience more symptoms of depression and anxiety have a SCD pain episode, it could make it harder for them to cope effectively with the pain, leading to increased impairments in social functioning. This is consistent with findings from a study that indicated that youth with SCD who experienced vaso-occlusive pain were at a greater risk for medical complications during depressive periods, as they had lower pain thresholds and impaired pain-coping abilities.…”

Differences in the prevalence of mental health disorders among Black American adults with sickle cell disease compared to those with non‐heritable medical conditions or no medical conditions

“…As a result, they experience increased risk for comorbidities and poor outcomes 34 , 35 . There is an urgent need for mental health screening and effective, evidence‐based treatment of psychological disorders in routine SCD care 7,35–39 …”

“…34,35 There is an urgent need for mental health screening and effective, evidencebased treatment of psychological disorders in routine SCD care. 7,[35][36][37][38][39]…”

Development and feasibility testing of the Comfort Ability Program for sickle cell pain: A patient-informed, video-based pain management intervention for adolescents with sickle cell disease.

“…Children with SCD also frequently report negative thinking, anxiety, and passive coping strategies. These emotional and behavioral correlates of SCD have a direct impact on a child’s health with research finding that negative thinking and poor coping is related to a higher number of emergency room visits and more frequent inpatient admissions (Raphael et al, 2012; Reader et al, 2019).…”