Prevalence of Depression and Anxiety in Adult Patients with β-Thalassemia Major and Intermedia

Abstract

Objective:

To evaluate and compare the prevalence and risk factors for anxiety and depression in adults with β-thalassemia major (TM) and intermedia (TI).

Method:

A cross-sectional study of TI and TM patients at a Chronic Care Center in Lebanon. A total of 80 patients agreed to participate (32 TI (median age 24 years) and 48 TM (median age 23 years)). The Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) questionnaires were used to assess the depression and anxiety levels of patients, respectively. Data on patient demographics, clinical complications, and socioeconomic status were also collected.

Results:

Patients with TM had a significantly longer median duration with a known thalassemia diagnosis than patients with TI (p < 0.001). A considerable proportion of patients had depression (35.0%), State (S)-anxiety (22.5%) or Trait (T)-anxiety (36.2%). Patients with TI had a higher median S-anxiety score compared with TM (p = 0.035), although the median T-anxiety and depression scores were similar. On linear regression analysis, the significant association between the thalassemia diagnosis (TM versus TI) and S-anxiety score (beta: 5.740; 95% CI: 0.201 to 11.278; p = 0.042) was no longer observed upon adjustment for the co-variate duration with a known thalassemia diagnosis (beta: 3.162; 95% CI: −2.949 to 9.274; p = 0.306).

Conclusions:

A considerable proportion of adult patients with TM and TI show evidence of depression and anxiety. Patients with TI are more liable to state anxiety than TM patients of a similar age, which is attributed to a shorter duration of living with a thalassemia diagnosis.

Keywords

thalassemia depression anxiety

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References

Weatherall

. The inherited diseases of hemoglobin are an emerging global health burden. Blood 2010;115:4331–4336.

Rund

Rachmilewitz

. Beta-thalassemia. New England Journal of Medicine 2005;353:1135–1146.

Sankaran

Lettre

Orkin

Hirschhorn

. Modifier genes in Mendelian disorders: The example of hemoglobin disorders. Annals of the New York Academy of Sciences 2010;1214:47–56.

Rachmilewitz

Giardina

. How I treat thalassemia. Blood 2011;118:3479–3488.

Taher

Musallam

Cappellini

Weatherall

. Optimal management of beta thalassaemia intermedia. British Journal of Haematology 2011;152:512–523.

Pakbaz

Treadwell

Yamashita

Quirolo

Foote

Quill

Singer

Vichinsky

. Quality of life in patients with thalassemia intermedia compared to thalassemia major. Annals of the New York Academy of Sciences 2005;1054:457–461.

Musallam

Khoury

Abi-Habib

Bazzi

Succar

Halawi

Hankir

Koussa

Taher

. Health-related quality of life in adults with transfusion-independent thalassaemia intermedia compared to regularly transfused thalassaemia major: New insights. European Journal of Haematology 2011;87:73–79.

Sobota

Yamashita

Trachtenberg

Kohlbry

Kleinert

Giardina

Kwiatkowski

Foote

Thayalasuthan

Porter

Thompson

Schilling

Quinn

Neufeld

. Quality of life in thalassemia: A comparison of SF-36 results from the thalassemia longitudinal cohort to reported literature and the US norms. American Journal of Hematology 2011;86:92–95.

Azarkeivan

Hajibeigi

Alavian

Lankarani

Assari

. Associates of poor physical and mental health-related quality of life in beta thalassemia-major/intermedia. Journal of Research in Medical Sciences 2009;14:349–355.

10.

Musallam

Cappellini

Taher

. Challenges associated with prolonged survival of patients with thalassemia: Transitioning from childhood to adulthood. Pediatrics 2008;121:e1426–e1429.

11.

Mednick

Trachtenberg

Kleinert

Giardina

Kwiatkowski

Foote

Thayalasuthan

Porter

Thompson

Schilling

Quinn

Neufeld

Yamashita

. Symptoms of depression and anxiety in patients with thalassemia: Prevalence and correlates in the thalassemia longitudinal cohort. American Journal of Hematology 2010;85:802–805.

12.

Messina

Colombo

Cassinerio

Ferri

Curti

Altamura

Cappellini

. Psychosocial aspects and psychiatric disorders in young adult with thalassemia major. Internal and Emergency Medicine 2008;3:339–343.

13.

West

. An Arabic validation of a depression inventory. International Journal of Social Psychiatry 1985;31:282–289.

14.

Beck

. Depression: Causes and treatment. Philadelphia, PA: University of Pennsylvania Press, 2006.

15.

Abdullatif

. Adaptation of the state trait anxiety inventory in Arabic: A comparison with the American STAI. Tampa, FL: University of South Florida, Department of Psychology, 2004:55.

16.

Speilberger

Gorsuch

Lushene

Vagg

Jacobs

. The state-trait anxiety inventory for adults manual. Palo Alto, CA: Mind Garden, 1983.

17.

Lisspers

Nygren

Söderman

. Hospital Anxiety and Depression Scale (HAD): Some psychometric data for a Swedish sample. Acta Psychiatrica Scandinavica 1997;96:281–286.

18.

Cappellini

Bejaoui

Agaoglu

Porter

Coates

Jeng

Lai

Mangiagli

Strauss

Girot

Watman

Ferster

Loggetto

Abish

Cario

Zoumbos

Vichinsky

Opitz

Ressayre-Djaffer

Abetz

Rofail

Baladi

. Prospective evaluation of patient-reported outcomes during treatment with deferasirox or deferoxamine for iron overload in patients with beta-thalassemia. Clinical Therapeutics 2007;29:909–917.

19.

Taher

Al Jefri

Elalfy

Al Zir

Daar

Rofail

Baladi

Habr

Kriemler-Krahn

El-Beshlawy

. Improved treatment satisfaction and convenience with deferasirox in iron-overloaded patients with beta-thalassemia: Results from the ESCALATOR Trial. Acta Haematologica 2010;123:220–225.

20.

Borras

Constant

. Depression and beta-thalassemia: A genetic link? Acta Neuro-pschiatrica 2007;19:134.

21.

Pradhan

Shah

Rao

Ashturkar

Ghaisas

. Psychopathology and self-esteem in chronic illness. Indian Journal of Pediatrics 2003;70:135–138.

22.

Mikelli

Tsiantis

. Brief report: Depressive symptoms and quality of life in adolescents with β-thalassaemia. Journal of Adolescence 2004;27:213–216.

23.

Sabry

Salama

. Cognitive abilities, mood changes and adaptive functioning in children with β thalassaemia. Currrent Psychiatry 2009;16:244–254.

24.

Di Palma

Vullo

Zani

Facchini

. Psychosocial integration of adolescents and young adults with thalassemia major. Annals of the New York Academy of Sciences 1998;850:355–360.

25.

McPherson

Thaniel

Minniti

. Transition of patients with sickle cell disease from pediatric to adult care: Assessing patient readiness. Pediatric Blood and Cancer 2009;52:838–841.

26.

Levine

. Health care transition in thalassemia: Pediatric to adult-oriented care. Annals of the New York Academy of Sciences 2010;1202:244–247.

27.

Taher

Musallam

Nasreddine

Hourani

Inati

Beydoun

. Asymptomatic brain magnetic resonance imaging abnormalities in splenectomized adults with thalassemia intermedia. Journal of Thrombosis and Haemostasis 2010;8:54–59.

28.

Musallam

Beydoun

Hourani

Nasreddine

Raad

Koussa

Taher

. Brain magnetic resonance angiography in splenectomized adults with beta-thalassemia intermedia. European Journal of Haematology 2011;87:539–546.

29.

Karimi

Bagheri

Rastgu

Rachmilewitz

. Magnetic resonance imaging to determine the incidence of brain ischaemia in patients with beta-thalassaemia intermedia. Thrombosis and Haemostasis 2010;103:989–993.

30.

Manfre

Giarratano

Maggio

Banco

Vaccaro

Lagalla

. MR imaging of the brain: Findings in asymptomatic patients with thalassemia intermedia and sickle cell-thalassemia disease. AJR American Journal of Roentgenology 1999;173:1477–1480.

31.

Musallam

Nasreddine

Beydoun

Hourani

Hankir

Koussa

Haidar

Taher

. Brain positron emission tomography in splenectomized adults with beta-thalassemia intermedia: Uncovering yet another covert abnormality. Annals of Hematology 2012;91:235–241.

32.

Shu

Liu

Gong

Tan

Stone

Zhang

Jiang

. White matter abnormalities in first-episode, treatment-naive young adults with major depressive disorder. American Journal of Psychiatry 2007;164:823–826.

33.

Clarke

Currie

. Depression, anxiety and their relationship with chronic diseases: A review of the epidemiology, risk and treatment evidence. Medical Journal of Australia 2009;190:54–60.