(PS2-100) Examining Hospitalizations and Associations Between Pain and Psychopathology in Adults with Sickle Cell Disease

Abstract Text:

Background: Hallmark features in sickle cell disease (SCD), which affects individuals identifying predominantly as Black and/or African American, are acute and chronic pain. In systematic reviews, depression rates also range up to 57% in individuals with SCD. Co-occurring psychological and physical health difficulties, such as exposure to potentially traumatic events and sleep disturbances, are also commonly reported by individuals with SCD. Despite the frequency with which mental health problems occur in SCD, few studies have examined associations between mental health difficulties, SCD pain, and hospitalizations. Understanding these associations may help identify cognitive-behavioral treatment targets that could eventually mitigate adverse health outcomes in a population underrepresented in cognitive-behavioral treatment trials and research.

Methods: We conducted a retrospective, Institutional Review Board approved chart review in individuals with SCD presenting to a sickle cell clinic in the Southeastern United States. The following outcome data were extracted: depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), pain (operationalized by proxy using morphine milligram equivalents [MME]), past-year emergency department visits and hospital stays, and hospital stays over the past three years. Descriptive statistics and Pearson correlations were calculated. Data from 80 participants (Mage = 22.49, SD = 2.23, 60% female) were included, with varying levels of data missingness. All individuals identified as Black and/or African American.

Results: An average of 7.29 (SD = 9.15) and 2.00 (SD = 2.93) past three-year and one-year hospital stays was reported, respectively. Average past one-year emergency department visits was 4.26 (SD = 7.19). Depression was positively correlated with greater three-year hospital admissions (n = 30, r = .372, p = .043) but not one-year hospital stays (n = 30, r = .298, p = .119), MME (n = 21; r = .254, p = .266), or one-year emergency department visits (n = 30, r = .262, p = .162). More three-year hospital admissions were positively correlated with one-year emergency department visits (n = 80, r = .641, p < .001) as well as MME/day (n = 55, r = .368, p = .006). Further, more one-year emergency department visits were related to higher MME/day (n = 55, r = .287, p = .033). More one-year hospital admissions were related to three-year admissions (n = 40, r = .856, p < .001) and higher one-year emergency department visits (n = 40, r = .482, p = .002), but not MME/day (n = 30, r = .393, p = .057). While anxiety and depression were positively correlated (n = 27, r = .653, p < .001), anxiety was not correlated with pain, emergency department visits, or hospital admissions (ps > .05).

Conclusion: Depression may be relevant to consider addressing within the context of long-term hospital utilization in individuals with SCD. Results inform cognitive-behavioral interventions for individuals with SCD who have been historically excluded from cognitive-behavioral research and interventions and suggest that such interventions may focus on ameliorating depression difficulties.