Witkop Michelle L, Lambing Angela, Nichols Cynthia D, Munn James E, Anderson Terry L, Tortella Bartholomew J
Nursing Department, Northern Regional Bleeding Disorders Center, Munson Medical Center, Traverse City, MI, USA.
Nursing Department, Henry Ford Hemophilia and Thrombosis Treatment Center, Detroit, MI, USA.
Patient Prefer Adherence. 2019 Sep 20;13:1577-1587. doi: 10.2147/PPA.S212723. eCollection 2019.
Depression, 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.
Adults 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.
Among 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 (<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 (χ <0.05). Significant correlations were found between PHQ-9 and GAD-7 (<0.0001), PHQ-9 and FPS-R (=0.0004), PHQ-9 and VERITAS (=0.01), GAD-7 and FPS-R (=0.02), and GAD-7 and VERITAS (0.001).
Depression 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.
抑郁、焦虑、疼痛和治疗依从性之间存在相互影响，而在血友病患者中这种情况尚未得到广泛研究。本研究探讨了成年血友病患者的抑郁、焦虑、慢性疼痛与治疗依从性之间的关系。
自我报告患有甲型或乙型血友病的成年人完成了横断面IMPACT QoL II调查。分析了抑郁（9项患者健康问卷[PHQ-9]）、焦虑（7项广泛性焦虑障碍量表[GAD-7]）、慢性疼痛（面部疼痛量表修订版[FPS-R]）、社会支持（杜克大学北卡罗来纳功能性社会支持问卷）、疼痛控制水平、凝血因子治疗依从性（VERITAS-Pro或-PRN）以及既往抑郁/焦虑情况。
在200名参与者中（男性占77.3%；女性占22.8%），54%的人PHQ-9得分及52%的人GAD-7得分表明存在中度至重度抑郁或焦虑，但均未被诊断出患有这两种疾病。PHQ-9得分≥10（中度至重度抑郁）的参与者比PHQ-9得分<10的参与者治疗依从性更低（<0.05）。与PHQ-9或GAD-7得分<10的参与者相比，PHQ-9或GAD-7得分≥10的参与者更有可能报告疼痛未得到控制且社会支持较少（χ<0.05）。发现PHQ-9与GAD-7之间（<0.0001）、PHQ-9与FPS-R之间（=0.0004）、PHQ-9与VERITAS之间（=0.01）、GAD-7与FPS-R之间（=0.02）以及GAD-7与VERITAS之间（0.001）存在显著相关性。
血友病患者中抑郁和焦虑的诊断不足。抑郁与焦虑、疼痛及较低的治疗依从性相关。虽然治疗提供者在诊断中起重要作用，但社会工作者在抑郁和焦虑筛查中可能起关键作用。本研究强调了对这些疾病进行定期筛查和治疗的重要性。
