Interrelationship between depression, anxiety, pain, and treatment adherence in hemophilia: results from a US cross-sectional survey

Figures & data

Table 1 Demographic and clinical characteristics of study participants

Parameter	Patients (N=200)
Age, mean (range), years^a	36.5 (18–86)
Sex, n (%)^a
Male	146 (77)
Female	43 (23)
Race, n (%)^a
White	128 (68)
Black	27 (14)
Asian	3 (2)
Native American or Alaskan native	2 (1)
Native Hawaiian or other Pacific islander	2 (1)
Other	27 (14)
Hemophilia type, n (%)^b
A	161 (81)
B	39 (20)
Hemophilia severity, n (%)
Mild	48 (24)
Moderate	16 (8)
Severe	136 (68)
Type of treatment, n (%)^b
On-demand	81 (41)
Before activity	11 (6)
Prophylaxis	108 (54)
Inhibitor status, n (%)^b
Yes	79 (40)
No	121 (61)

Notes: ^an=189. Sex and race for 11 patients are unknown. ^bPercentages may not add to 100% because of rounding.

Figure 1 Prevalence of diagnosed depression, by PHQ-9 score^a (A) and of diagnosed anxiety, by GAD-7 score^b (B). Percentages were based on n=186 and n=184, respectively. P≤0.001 and P<0.01, based on χ² analysis, respectively.

Notes: ^aPHQ-9 score ≥10 was designated as the criterion for moderate to severe depression, and PHQ-9 score <10 was the criterion for mild or no depression, based on the literature.^{8 b}GAD-7 score ≥10 was designated as the criterion for moderate-to-severe anxiety, and GAD-7 score <10 was the criterion for mild or no anxiety, based on the literature.⁷
Abbreviations: GAD-7, 7-item Generalized Anxiety Disorder scale; PHQ-9, 9-item Patient Health Questionnaire depression scale.

Figure 2 Perceived social support, measured on the DUFSS, stratified by severity of depression and anxiety. The scale contains 8 items; 5 items assess social support, and 3 items assess affective support. Each response is scored on a scale of 1–5. The average score increases as the level of social support increases.

Abbreviations: DUFSS, Duke-UNC Functional Social Support Questionnaire; GAD-7, 7-item Generalized Anxiety Disorder scale; PHQ-9, 9-item Patient Health Questionnaire depression scale.

Figure 3 Prevalence of treatment adherence, stratified by presence of moderate-to-severe (A) depression (P<0.05, χ² analysis) or (B) anxiety (P=NS, χ² analysis).^aPercentages were based on n=95.

Notes: ^aBased on the literature, PHQ-9 score ≥10 and GAD-7 score ≥10 were designated as the criteria for moderate-to-severe depression and anxiety, respectively; PHQ-9 score <10 and GAD-7 score <10 were designated as the criteria for mild or no depression and anxiety.⁷,⁸
Abbreviation: PHQ-9, 9-item Patient Health Questionnaire depression scale.

Figure 4 Prevalence of participants’ level of pain control, stratified by presence of moderate-to-severe (A) depression (P≤0.001, χ² analysis) or (B) anxiety (P<0.05, χ² analysis). ^aPercentages were based on n=193.

Notes: ^aBased on the literature, PHQ-9 score ≥10 and GAD-7 score ≥10 were designated as the criteria for moderate-to-severe depression and anxiety, respectively; PHQ-9 score <10 and GAD-7 score <10 were designated as the criteria for mild or no depression and anxiety, respectively.⁷,⁸
Abbreviations: GAD-7, 7-item Generalized Anxiety Disorder scale; PHQ-9, 9-item Patient Health Questionnaire depression scale.

Table 2 Correlation matrix of level of depression, anxiety, treatment adherence, and pain^a

Parameter	PHQ-9	GAD-7	VERITAS^b	FPS-R
PHQ-9	–	–	–	–
GAD-7	0.77 (P<0.001) N=197	–	–	–
VERITAS	0.18 (P=0.01) N=197	0.23 (P=0.001) N=198	–	–
FPS-R^c	0.31 (P=0.0004) N=127	0.22 (P=0.02) N=127	−0.004 (P=0.961) N=127	–

Notes: ^aCorrelation parameters (Spearman’s rho and corresponding P-value) between variables are shown. ^bVERITAS-Pro or VERITAS-PRN. ^cDifferences in patient numbers are because those who reported that they did not have chronic pain were not asked to the complete the FPS-R.

Abbreviations: FPS-R, Faces Pain Scale–Revised; GAD-7, 7-item Generalized Anxiety Disorder scale; NA, not applicable; NS, not significant; PHQ-9, 9-item Patient Health Questionnaire depression scale; VERITAS, Validated Hemophilia Regimen Treatment Adherence Scale.

Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. doi:10.1046/j.1525-1497.2001.016009606.x11556941

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