Precariousness Represents an Independent Risk Factor for Depression in Children With Sickle Cell Disease.

While the prevalence and impact of depression have been widely described in sickle cell disease, its relationship with precariousness has never been studied. This study aimed to describe the prevalence of depression and its relationship with clinical and demographic factors including social precariousness in children with sickle cell disease in French Guiana. We included children aged 12-18 years with sickle cell disease from the Sickle Cell Reference Center in French Guiana. A simple depression questionnaire "Child depression inventory 2" was proposed and completed by a clinical examination and consultation by a psychologist. Using the known assessment of health inequalities and poverty in health screening centres (EPICES) score, we developed a composite precariousness score that uses five items (each item is scored from 0 to 2). According to the chosen items, precariousness was defined as a score ≥5. The prevalence of depression was 42.5% [95% CI: 31.5-54]. The median age was 15 years [95% CI: 13-17]. The age distribution peaked at 14 years in patients with depression. There were 76% of precarious patients in the depressed group and 18% in the control group (  < 0.0001). In multivariate analysis, genotype SC (OR = 7.66, [1.17; 50.13], =0.0338) and precariousness (OR = 15.68, [4.73; 51.94],   < 0.0001) were associated with higher rates of depression. Baseline hemoglobin levels (OR = 0.48, [0.27; 0.88], =0.0173) were also associated with lower rates of depression. Despite free healthcare, precariousness is an independent risk factor for depression.