Department of Paediatrics, Faculty of Medicine, University of Kelaniya, Ragama, Sri Lanka.
Colombo North Teaching Hospital, Ragama, Sri Lanka.
PLoS One. 2020 Feb 11;15(2):e0228733. doi: 10.1371/journal.pone.0228733. eCollection 2020.
Thalassaemia is a chronic disease which requires lifelong treatment in a majority. Despite recent advances in the medical care, minimal attempts are made to improve psychological health in these patients. In this study, we aim to describe the psychological morbidity in patients with transfusion dependent β-thalassaemia and their mothers in Sri Lanka.
This case control study was conducted in the three largest thalassaemia centres of Sri Lanka. All patients with transfusion dependent β-thalassaemia aged 4-18 years were recruited as cases whilst a randomly selected group of children without chronic diseases were recruited as controls. Psychological morbidity of children was assessed using the Strengths and Difficulties Questionnaire and depressive symptoms of mothers was assessed by the Centre for Epidemiological Studies Depression Scale.
288 transfusion dependent β-thalassaemia patients and equal number of controls were recruited. Abnormal emotional, conduct, hyperactivity and peer relationship symptom scores were reported by 18%, 17%, 9% and 14% of patients with thalassaemia respectively. Prevalences of abnormal psychological symptom scores in all domains were significantly higher among patients compared to controls. Abnormal conduct symptoms were significantly more prevalent among patients with HbE β-thalassaemia and those with suboptimal pretransfusion haemoglobin levels, lower transfusion volumes, hypothyroidism and undernutrition. Short stature was associated with abnormal emotional and hyperactivity scores. Depressive symptoms were significantly higher among mothers of patients with thalassaemia. Higher depressive symptom scores in mothers were significantly associated with abnormal emotional, conduct and peer relationship symptom scores in children.
A higher proportion of patients with transfusion dependent β-thalassaemia had abnormal psychological symptom scores. Abnormal conduct symptoms were more prevalent among patients with HbE β-thalassaemia, those who were inadequately transfused and having hypothyroidism and undernutrition. Mothers of the children with transfusion dependent β-thalassaemia had significantly higher depressive symptoms which were significantly associated with psychological symptoms among children.
地中海贫血是一种需要终身治疗的慢性疾病，在大多数情况下都需要治疗。尽管医疗技术近年来取得了进步，但很少有人尝试改善这些患者的心理健康。本研究旨在描述斯里兰卡输血依赖型β地中海贫血患者及其母亲的心理发病率。
本病例对照研究在斯里兰卡最大的三个地中海贫血中心进行。所有 4-18 岁的输血依赖型β地中海贫血患者均被招募为病例，而随机选择的一组无慢性疾病的儿童则被招募为对照。采用儿童长处与困难问卷评估儿童的心理发病率，采用流行病学研究中心抑郁量表评估母亲的抑郁症状。
共招募了 288 名输血依赖型β地中海贫血患者和同等数量的对照组。18%、17%、9%和 14%的地中海贫血患者分别报告存在异常情绪、行为、多动和同伴关系症状评分。与对照组相比，所有领域的异常心理症状评分在患者中更为常见。异常行为症状在 HbEβ地中海贫血患者和那些血红蛋白预处理水平不理想、输血量较低、甲状腺功能减退和营养不良的患者中更为常见。身材矮小与异常情绪和多动评分有关。地中海贫血患儿的母亲抑郁症状明显较高。母亲的抑郁症状评分越高，与儿童的异常情绪、行为和同伴关系症状评分显著相关。
更多的输血依赖型β地中海贫血患者存在异常心理症状评分。异常行为症状在 HbEβ地中海贫血患者、输血不足以及患有甲状腺功能减退和营养不良的患者中更为常见。患有输血依赖型β地中海贫血的儿童的母亲抑郁症状明显较高，与儿童的心理症状显著相关。
