Journal Article Annotations
2022, 4th Quarter
Annotations by Liz Prince, DO
In a sample of adults with sickle cell disease (SCD), racism-based discrimination contributed to depressive symptoms (as measured by the Center for Epidemiologic Studies Depression Scale (CES-D)). Depressive symptoms may act on pain through sleep disturbance (as measured by the insomnia severity index (ISI)).
Strength and weaknesses:
The separate analysis of pain diary ratings at baseline and 3 months allowed for consideration of different relationships between mediating factors (e.g. discrimination, depression, insomnia) depending on the pain assessment method. The study focused on racism-based discrimination, but adults with SCD also face disease-based discrimination, which has also been associated with pain in prior studies. Participants in this study from a single academic hospital reported low levels of racism-based discrimination in healthcare settings which may not be generalizable as many patients do not receive treatment in institutions with comprehensive sickle cell centers.
Interventions targeting mood and sleep may be important for the treatment of SCD-related painexperiences. Discrimination in healthcare settings negatively impacts this patient population and interferes with adequate and appropriate treatment. The C-L psychiatrist can advocate for systems changes to minimize the discrimination experience for patients, as well as ensuring depression and insomnia are adequately assessed and managed in this patient population.
Baseline cognitive test scores were lower for adults with sickle cell disease (SCD) than the comparison group. At seven year follow up, adults with SCD demonstrated significant decline in cognitive testing scores. However, patients with higher education had limited or no significant decrease in performance over seven-year period.
Strength and weaknesses:
The non-SCD comparison group was not followed longitudinally, so there are only baseline comparisons. The seven-year longitudinal follow up is a strength, as existing literature on adults with SCD is typically shorter. However, the long follow up period led to 42% attrition, with almost 15% of the baseline SCD cohort dying during the study period.
SCD is associated with progressive cognitive decline. Unrecognized neurocognitive dysfunction may lead providers to have unrealistic expectations as patients receiving complicated medical instructions may lack the executive function to follow providers’ instructions.
In the one-year post-hematopoietic stem cell transplantation (HCT) 43% (n=6) of young adult patients with SCD experienced suicidal ideation. All 6 had a history of major depressive disorder (MDD) and/or suicidal ideation (SI)prior to HCT. This was a small study, with only 14 patients included.
Nevertheless, it is a good reminder that C-L psychiatrists should be aware of the strong association of depression with sickle cell disease, especially in patients undergoing curative therapies. These treatments are life-altering, and the process is stressful for an already vulnerable population. Appropriate psychiatric screening, monitoring, and support is needed for young adult patients with SCD undergoing HCT.
This obituary describes the life and accomplishments of a man with sickle cell disease. Mr. Newman’s life story also highlights challenges associated with this illness: the loss of siblings to the genetic disease, likely cognitive decline, and his tragically early death at the age of 43. As discussed by Ampomah et al, declining brain health and cognitive impairment are major complications of sickle cell disease. McGill at all discuss how discrimination, particularly in health care settings, negatively impact patients. Despite the development of disease modifying therapies, life expectancy for patients with SCD remains reduced by an estimated 20 years.