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Depression, Anxiety, and Stress Comorbidities in Sickle Cell Anemia Patients With Vaso-occlusive Crisis

Mahdi, Najat MD* †; Al-Ola, Khadija MD*; Khalek, Nahed Abdel MD; Almawi, Wassim Y. PhD

Journal of Pediatric Hematology/Oncology: July 2010 - Volume 32 - Issue 5 - p 345-349
doi: 10.1097/MPH.0b013e3181d869d5
Original Articles

We investigated the association of sickle cell anemia (SCA) vaso-occlusive crisis (VOC) with depression, anxiety, and stress disorders among Bahraini patients and controls. This was a cross-sectional study that involved administering Depression Anxiety Stress Scales (DASS-21) consisting of structured depression, anxiety, and stress scales to SCA patients with (n=138) and without (n=105) VOC. Multinomial regression and correlation analysis were used in assessing the association of VOC with depression and/or anxiety and/or stress, after adjusting for other covariates. Significantly higher proportion of VOC patients was found among the severe-extremely severe anxiety (P<0.002) and stress (P=0.001) groups; the frequency of depressed patients was comparable between the 2 groups. Adjusting for age, sex, income, number of affected individuals per family, and HbS levels, mild-moderate (P=0.042; odds ratio=2.00; 95% confidence interval=1.03-3.91) and severe-extremely severe (P=0.004; odds ratio=4.43; 95% confidence interval=1.59-12.34) anxiety were independently associated with VOC. Both depression and stress were not associated with VOC after adjusting for these covariates. These results suggest a positive contribution of VOC to the increased rates of anxiety disorders among SCA patients, thereby recommending counseling SCA patients with repeated VOC for these psychologic comorbidities, in particular anxiety.

*Department of Pediatrics, Salmaniya Medical Complex

Department of Medical Biochemistry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Bahrain

College of Medicine, University of Sharjah, Sharjah, United Arab Emirates

Reprints: Wassim Y. Almawi, PhD, Department of Medical Biochemistry, College of Medicine & Medical Sciences, Arabian Gulf University, PO Box 22979, Manama, Bahrain (e-mail:

Received for publication November 8, 2009; accepted February 8, 2010

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

© 2010 Lippincott Williams & Wilkins, Inc.