Prevalence and treatment of depression in children and adolescents with sickle cell disease: a retrospective cohort study

Abstract

Objective: To describe the prevalence and treatment of comorbid depressive disorders in children and adolescents diagnosed with sickle cell disease.

Method: A retrospective cohort design evaluating South Carolina Medicaid medical and pharmacy claims between January 1, 1996, and December 31, 2006, was employed to identify 2,194 children and adolescents aged 17 years and younger diagnosed with sickle cell disease. Cohorts diagnosed with and without comorbid unipolar depressive disorders (using DSM-IV-TR criteria) were then compared.

Results: Forty-six percent of the sickle cell disease cohort was diagnosed with a depressive disorder (n = 1,017), either dysthymia (90%) or major depressive disorder (10%). Dysthymia was diagnosed at approximately 9 years of age, whereas major depressive disorder was diagnosed at approximately 14 years of age. Compared with the controls, the sickle cell disease cohort with depression had more acute vaso-occlusive pain and acute chest syndrome visits per year, developed more complications with related organ damage, and incurred significantly higher outpatient, acute (emergency + inpatient), and total sickle cell disease care costs. The depression cohort was primarily treated with selective serotonin reuptake inhibitors (SSRIs; 12%) or serotonin-norepinephrine reuptake inhibitors (SNRIs; 10%) for approximately 9 months. Although alleviating the comorbid depression might positively affect their sickle cell disease pain, over 80% of the patients received no antidepressant medications, and many of the prescribed SSRIs and SNRIs have previously shown no impact on relieving chronic pain.

Conclusions: Comorbid depression in sickle cell disease is associated with adverse course and outcomes. These findings underscore the need for earlier and more aggressive treatment of comorbid depression by primary care or psychiatric providers in order to reduce the chronic, severe pain-depression burden on these patients.