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

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Chi-squared tests of the distributions of demographic risk factors among SCD subjects from Baltimore, MD and Washington, DC revealed no statistically significant or clinically important differences between the two groups. Thus, data for SCD patients from the two sites were pooled. This same two-step analytical process was also conducted for the non-SCD group. Of the 102 SCD subjects recruited, 79.4% had sickle cell anemia, 15.6% had sickle hemoglobin-C disease and 5.0% had sickle B-thalassemia. With regards to clinical severity, 71.6% had high, 14.7% had medium and 13.7% had low clinical SCD severity. There were statistically significant differences in educational level, income and employment status for subjects with SCD compared to those without SCD (p<0.05). Table 1 shows the distribution of covariates stratified by clini­cal severity of SCD. African Americans with SCD were more likely to have lower levels of education, more likely to have incomes of <$ 15,000, and more likely to be unemployed or on disability compared to African Americans without SCD. No statistically significant differences were observed in age, gender or marital status between subjects with SCD and non-SCD subjects. Three subjects were missing data for depressive symptoms or clinical severity and were excluded from further analysis. Income data were missing for 40 subjects, and as a result, employment status was therefore used as a measure of socioeconomic position.

Although CES-D scores above the cut-off of >4 occurred more frequently among SCD subjects as a group than those without SCD, the difference was not statistically significant (38.6% vs. 27.5%). The differences were largest for those with high and low clinical SCD severity compared to those without SCD. For those with medium clinical SCD severity, the prevalence of elevated depressive symptoms was similar to those subjects without SCD as shown in Table 1. The mean and standard deviation values for summary CES-D scores for non-SCD subjects, and SCD subjects with low, medium and high clinical severity were 2.33 ± 2.20, 3.00 ± 2.61, 2.80 ± 2.46 and 3.15 ± 2.57, respectively. You can afford your pills. Buy levitra canadian pharmacy online
Table 1. Selected characteristics of study subjects according to sickle cell disease (SCD) status

	Non-SCD		SCD Clinical Severity
Characteristics	(n=103) %	Low (n=13) %	Medium (n=15) %	High (n=73) %	P Value
Age (Years) 18-29 30-39 40-49 50-70	37.9 26.2 22.3 13.6	23.1 23.1 30.8 23.1	40.0 33.3 13.3 13.3	39.7 28.8 21.9 9.6	NS
Recruitment Location Washington Baltimore	69.9 30.1	46.2 53.8	66.7 33.3	74.0 26.0	NS
Gender Female Male	55.3 44.7	76.9 23.1	40.0 60.0	56.2 43.8	NS
Education < High school > High school	23.3 76.7	46.2 53.8	46.7 53.3	50.7 49.3	O.01
Household income <$ 15,000 $15,000-334,999 >$35,000	17.6 40.0 42.4	27.3 18.2 54.5	45.5 9.1 45.5	54.4 22.8 22.8	<0.01
Employment Status Employed, student or retired Homemaker Unemployed or on disability	93.2 1.9 4.9	46.2 23.1 30.8	60.0 13.3 26.7	41.1 6.8 52.1	O.01
Marital Status Married Single Other	21.4 59.2 19.4	15.4 46.2 38.5	13.3 73.3 13.3	19.6 59.3 21.1	NS
Depressed Yes                                        27.5                   38.5                 26.7 No                                         72.5                    61.5                  73.3 p values derived from Chi-squared tests of homogeneity; NS: Not statistically significant				40.3 59.7	NS

Table 2. Risk of depressive symptoms for subjects with and without sickle cell disease (SCD) stratified by clinical severity

SCD Status	n	Bivariate Model OR (95% CI)	Multivariable Model OR (95% CI)
No SCD	102	1.00 (reference)	1.00 (reference)
Low SCD severity	13	1.65 (0.50, 5.48)	1.19 (0.32, 4.45)
Medium SCD severity	15	0.96 (0.28, 3.27)	0.69 (0.19, 2.49)
High SCD severity	72	1.78 (0.94, 3.38)	1.37 (0.62, 3.02)

Table 2 shows the results from logistic regression in bivariate and multivariable analysis. Inbivariate analysis, those with different levels of clinical severity for SCD were not more likely to have elevated depressive symptoms than those without SCD, but the results approached statistical significance for those with high clinical severity in bivariate analysis. In multivariable analysis, employment status and marital status were independently associated with elevated depressive symptoms and were included in the adjusted model. The odds of having elevated depressive symptoms were not increased for the three SCD groups compared to subjects without SCD after adjusting for employment status and marital status. canadian pharmacy cialis