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J Natl Med Assoc. 2006 March; 98(3): 365–369.
PMCID: PMC1421516

Association between elevated depressive symptoms and clinical disease severity in African-American adults with sickle cell disease.


OBJECTIVE: The purpose of this cross-sectional study was to examine the association between elevated depressive symptoms and the clinical severity of sickle cell disease (SCD) using African-American adults with and without SCD. STUDY DESIGN: The population consisted of 102 African-American adults with SCD, diagnosed using hemoglobin electrophoresis, individually matched on age (+/-5 years), gender and recruitment location to 103 African-American adults without SCD (mean age of all subjects was 35.4 years, 55.6% female). Logistic regression was used to examine the association between SCD clinical severity and elevated depressive symptoms in bivariate and multivariable analyses. RESULTS: The prevalence of elevated depressive symptoms as measured using the 10-item Center for Epidemiological Studies Depression Scale (CES-D) was 38.6% in those with SCD, compared to 27.5% in those without SCD; however, this difference was not statistically significant (p>0.05). Compared to African Americans without SCD, African Americans with SCD were less educated, had lower incomes, and were more likely to be unemployed or disabled (p<0.01). The odds of having elevated depressive symptoms were 1.78 (CI: 0.94, 3.38) for those with high clinical SCD severity compared to those without SCD in bivariate analysis and 1.37 (CI: 0.62, 3.02) in multivariable analysis after adjusting for socioeconomic factors. CONCLUSIONS: The reported relationship between elevated depressive symptoms and SCD may be a result of the adverse economic conditions associated with SCD.

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  • Taylor LB, Nowak AJ, Giller RH, Casamassimo PS. Sickle cell anemia: a review of the dental concerns and a retrospective study of dental and bony changes. Spec Care Dentist. 1995 Jan-Feb;15(1):38–42. [PubMed]
  • Yaster M, Kost-Byerly S, Maxwell LG. The management of pain in sickle cell disease. Pediatr Clin North Am. 2000 Jun;47(3):699–710. [PubMed]
  • Hasan Syed Parwez, Hashmi Shahzad, Alhassen Mohammed, Lawson William, Castro Oswaldo. Depression in sickle cell disease. J Natl Med Assoc. 2003 Jul;95(7):533–537. [PMC free article] [PubMed]
  • Belgrave FZ, Molock SD. The role of depression in hospital admissions and emergency treatment of patients with sickle cell disease. J Natl Med Assoc. 1991 Sep;83(9):777–781. [PMC free article] [PubMed]
  • Wison Schaeffer JJ, Gil KM, Burchinal M, Kramer KD, Nash KB, Orringer E, Strayhorn D. Depression, disease severity, and sickle cell disease. J Behav Med. 1999 Apr;22(2):115–126. [PubMed]
  • Irwin M, Artin KH, Oxman MN. Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D) Arch Intern Med. 1999 Aug 9;159(15):1701–1704. [PubMed]
  • Wilson Robert S, Bienias Julia L, Mendes de Leon Carlos F, Evans Denis A, Bennett David A. Negative affect and mortality in older persons. Am J Epidemiol. 2003 Nov 1;158(9):827–835. [PubMed]
  • Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J. Two shorter forms of the CES-D (Center for Epidemiological Studies Depression) depression symptoms index. J Aging Health. 1993 May;5(2):179–193. [PubMed]
  • Westerman MP, Bailey K, Freels S, Schlegel R, Williamson P. Assessment of painful episode frequency in sickle-cell disease. Am J Hematol. 1997 Mar;54(3):183–188. [PubMed]
  • Charache S, Terrin ML, Moore RD, Dover GJ, Barton FB, Eckert SV, McMahon RP, Bonds DR. Effect of hydroxyurea on the frequency of painful crises in sickle cell anemia. Investigators of the Multicenter Study of Hydroxyurea in Sickle Cell Anemia. N Engl J Med. 1995 May 18;332(20):1317–1322. [PubMed]
  • Inaba Akihide, Thoits Peggy A, Ueno Koji, Gove Walter R, Evenson Ranae J, Sloan Melissa. Depression in the United States and Japan: gender, marital status, and SES patterns. Soc Sci Med. 2005 Dec;61(11):2280–2292. [PubMed]
  • Riolo Stephanie A, Nguyen Tuan Anh, Greden John F, King Cheryl A. Prevalence of depression by race/ethnicity: findings from the National Health and Nutrition Examination Survey III. Am J Public Health. 2005 Jun;95(6):998–1000. [PubMed]
  • Kaufman JS, Cooper RS, McGee DL. Socioeconomic status and health in blacks and whites: the problem of residual confounding and the resiliency of race. Epidemiology. 1997 Nov;8(6):621–628. [PubMed]
  • DeRubeis Robert J, Hollon Steven D, Amsterdam Jay D, Shelton Richard C, Young Paula R, Salomon Ronald M, O'Reardon John P, Lovett Margaret L, Gladis Madeline M, Brown Laurel L, et al. Cognitive therapy vs medications in the treatment of moderate to severe depression. Arch Gen Psychiatry. 2005 Apr;62(4):409–416. [PubMed]
  • Kovacs M, Rush AJ, Beck AT, Hollon SD. Depressed outpatients treated with cognitive therapy or pharmacotherapy. A one-year follow-up. Arch Gen Psychiatry. 1981 Jan;38(1):33–39. [PubMed]
  • Rush AJ, Beck AT. Cognitive therapy of depression and suicide. Am J Psychother. 1978 Apr;32(2):201–219. [PubMed]

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