https://orcid.org/0000-0003-0758-286X
Abstract
Purpose
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.
Patients and methods
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.
Results
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 (P<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 (χ2 P<0.05). Significant correlations were found between PHQ-9 and GAD-7 (P<0.0001), PHQ-9 and FPS-R (P=0.0004), PHQ-9 and VERITAS (P=0.01), GAD-7 and FPS-R (P=0.02), and GAD-7 and VERITAS (P=0.001).
Conclusion
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.
Acknowledgment
The authors thank John M. McLaughlin, PhD, of Pfizer Inc, for his participation in the development of the original survey and for previous statistical analysis, and Christi Humphrey, MSW, for her review of this manuscript and expert opinion. The authors thank all of the survey participants for their time in contributing to this study. Jessica D. Herr, PharmD, and Barbara Zeman, PhD, of Peloton Advantage, LLC, an OPEN Health company, provided medical writing and editorial support, which were funded by Pfizer Inc.
Abbreviations
DUFSS, Duke-UNC functional social support questionnaire; FPS-R, Faces Pain Scale–Revised; GAD-7, 7-item Generalized Anxiety Disorder scale; IMPACT-QoL II, interrelationship between mood, pain, adherence to clotting factor treatment, and quality of life; NA, not applicable; NS, not significant; PHQ-9, 9-item Patient Health Questionnaire depression scale; PWH, person with hemophilia; VERITAS, Validated Hemophilia Regimen Treatment Adherence Scale.
Author contributions
All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
This study was sponsored by Pfizer Inc. MLW reports grants from Pfizer, Inc, during the conduct of the study. JEM has served on the advisory boards of Takeda, NovoNordisk, Genentech, CSL Behring, Octapharma, Shire/Baxalta and as Consultant for Bayer outside the submitted work. AL is currently employed by Bayer HealthCare. TLA is an employee of Pfizer Inc and may own stock/options in the company. BJT was an employee of Pfizer Inc at the time of manuscript preparation. CDN has no conflicts to disclose.