Association between Elevated Depressive Symptoms and Clinical Disease Severity in African-American Adults with Sickle Cell Disease. DISCUSSION

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This study did not detect a statistically significant increased risk of elevated depressive symptoms among African-American adults with SCD compared to African-American adults without SCD. The prevalence of elevated depressive symptoms in those with high clinical SCD severity and the overall prevalence for SCD subjects were 40.3% and 38.6%, respectively, similar to the values found in other studies of 44.0%, 56.5% and 43.4%. Analysis of the bivariate and multivariable results support the suggestion of two earlier studies that depression may be a result of the demographics of SCD and not necessarily a direct result of the disease severity. The confidence interval for the odds ratio examining the association between elevated depressive symptoms and high clinical SCD severity goes from a value that almost excludes one (1.78, CI: 0.94, 3.38) in bivariate analysis to a range not statistically or clinically relevant (1.37, CI: 0.62, 3.02) in multivariable analysis after adjusting for employment and marital status. The change was almost entirely due to employment status with marital status being a weak confounder. This finding suggests that socioeconomic position plays an important role in explaining any association between SCD and depression.

Although the estimates for the odds ratios may initially suggest that those with high and low clinical severity have a higher risk of depressive symptoms than those with medium clinical severity, the large confidence intervals that include one in those with low and medium clinical severity must be considered, and the results show no association between low or medium clinical severity and the risk of elevated depressive symptoms. Don’t be left without your medication get levitra plus cheaper online.

Subjects with the most clinically severe forms of SCD had the highest prevalence of depressive symptoms, and were the poorest and least educated, with the highest prevalence of disability or unemployment. Future prospective studies should include larger sample sizes in each strata of clinical severity to determine if the results from this study will be replicated and assess whether elevated depressive symptoms precede sickle cell crisis events or whether the converse is true.

Limitations of the study include the relatively small sample sizes for those with low and medium clinical severity, the cross-sectional nature of the data, and the brief measure for depressive symptoms. Use of a more comprehensive measure for depression would allow for the differentiation of specific psychosocial disorders rather than only a measure of the presence or absence of elevated depressive symptoms. Cialis professional canada

Although the results of this study did not find a statistically significant difference in the prevalence of elevated depressive symptoms, a clinically important difference of 11.1% comparing African Americans with SCD (38.6%>) to African Americans without SCD (27.5%) was observed, and it was likely a result of the socioeconomic difficulties associated with SCD. If the elevated depressive symptoms are a result of the socioeconomic conditions associated with SCD, behavioral or cognitive interventions will not have a lasting effect if the adverse economic circumstance that affects the behavior is not changed. Studies have shown that cognitive therapy can be as effective as antidepressant medications for the initial treatment of moderate-to-severe depression. Therefore, behavioral or cognitive interventions to manage depression and referral to community resources to help manage the economic difficulties associated with SCD may improve the quality of life for African Americans with SCD, but further research is needed.