International Committee on Mental Health in Cystic Fibrosis: Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus statements for screening and treating depression and anxiety

Abstract

Studies measuring psychological distress in individuals with cystic fibrosis (CF) have found high rates of both depression and anxiety. Psychological symptoms in both individuals with CF and parent caregivers have been associated with decreased lung function, lower body mass index, worse adherence, worse health-related quality of life, more frequent hospitalisations and increased healthcare costs. To identify and treat depression and anxiety in CF, the CF Foundation and the European CF Society invited a panel of experts, including physicians, psychologists, psychiatrists, nurses, social workers, a pharmacist, parents and an individual with CF, to develop consensus recommendations for clinical care. Over 18 months, this 22-member committee was divided into four workgroups: Screening; Psychological Interventions; Pharmacological Treatments and Implementation and Future Research, and used the Population, Intervention, Comparison, Outcome methodology to develop questions for literature search and review. Searches were conducted in PubMed, PsychINFO, ScienceDirect, Google Scholar, Psychiatry online and ABDATA by a methodologist at Dartmouth. The committee reviewed 344 articles, drafted statements and set an 80% acceptance for each recommendation statement as a consensus threshold prior to an anonymous voting process. Fifteen guideline recommendation statements for screening and treatment of depression and anxiety in individuals with CF and parent caregivers were finalised by vote. As these recommendations are implemented in CF centres internationally, the process of dissemination, implementation and resource provision should be closely monitored to assess barriers and concerns, validity and use.

Keywords: Cystic Fibrosis; Psychology.

Figure 1

A flexible, stepped-care model for assessing and treating depression and anxiety.

Figure 2

Screening and treatment of depression and anxiety: algorithm for individuals with cystic fibrosis (CF) (ages 12–adulthood). CBT, cognitive behavioural therapy; GAD-7, Generalised Anxiety Disorder 7-item Scale; IPT, interpersonal therapy; PHQ-9, Patient Health Questionnaire 9; SSRI, selective serotonin reuptake inhibitor.

Figure 3

Screening and treatment of depression and anxiety: algorithm for parents/caregivers. CBT, cognitive behavioural therapy; GAD-7, Generalised Anxiety Disorder 7-item Scale; IPT, interpersonal therapy; PHQ-9, Patient Health Questionnaire 9.