Depression in children and adolescents with sickle-cell disease.

OBJECTIVE

To look at the role of a standardized screening test for assessing depression in children and adolescents with and without sickle-cell disease and to compare findings with this instrument with clinical evaluations by child psychiatrists. In addition, to suggest the prevalence of clinical depression in children and adolescents with sickle-cell disease.

DESIGN

Nonrandomized, sequential sample of subjects, convenience control sample, prevalence study using the Children's Depression Rating Scale-Revised and an interview assessment by a child psychiatrist based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition.

SETTING

Comprehensive Sickle Cell Center outpatient clinic and ambulatory Resident Practice Clinic at the University of South Alabama Children's Medical Center, Mobile.

STUDY PARTICIPANTS

Patients aged 6 through 18 years with homozygous sickle-cell disease (hemoglobin SS) served as study subjects. Subjects of the same age and race who did not have sickle-cell disease served as controls.

MEASUREMENTS AND RESULTS

The mean Children's Depression Rating Scale-Revised total scores were 27.1 and 22.1 in study and control groups, respectively (P = .0073). Eleven (29%) of 38 children in the study group had scores indicating a high risk for clinical depression. Four (12%) of 34 children in the control group were in this category. The four items accounting for most of this significant difference were excessive fatigue, physical complaints, self-esteem, and morbid ideation. This contrasted with the clinical evaluation by a child psychiatrist in a clinical interview in which 13% of study subjects and 15% of control subjects had evidence of clinical depression (P = .85).

CONCLUSION

Excessive fatigue and physical complaint factors contributed to a high false-positive rate when the Children's Depression Rating Scale-Revised was used to screen for depression among patients with sickle-cell disease. Based on the clinical interview by a child psychiatrist, the actual prevalence of clinical depression was not increased in children with sickle-cell disease compared with those without this chronic illness.