Examining Mental Health, Education, Employment, and Pain in Sickle Cell Disease.
Examining Mental Health, Education, Employment, and Pain in Sickle Cell Disease.
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DOI：
10.1001/jamanetworkopen.2023.14070
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发表时间：
2023-05-01
影响因子：
13.8
通讯作者：
King, Allison A.
中科院分区：
文献类型：
--
作者：
Harris, Kelly M.;Preiss, Liliana;Varughese, Taniya;Bauer, Anna;Calhoun, Cecelia L.;Treadwell, Marsha;Masese, Rita;Hankins, Jane S.;Hussain, Faiz Ahmed;Glassberg, Jeffrey;Melvin, Cathy L.;Gibson, Robert;King, Allison A.
镰状细胞病 (SCD) 患者的教育程度、就业状况和心理健康与疼痛发作频率和严重程度有何关联？在对 2264 名 SCD 患者进行的横断面分析中，47.8% 的患者报告频繁疼痛（即 12 个月内≥ 4 次疼痛危机）。尽管教育程度和收入与疼痛发作频率或严重程度增加没有显着相关，但年龄、性别和抑郁与 SCD 相关疼痛相关。疼痛是复杂的，这些研究结果表明，有必要对 SCD 患者进行抑郁症和其他心理健康挑战的筛查，特别是对于那些疼痛发作频率和严重程度较高的患者。这项横断面研究探讨了镰状细胞病患者的教育程度、就业状况和心理健康与疼痛发作频率和严重程度的关系。与镰状细胞病 (SCD) 相关的疼痛很复杂，并且与健康的社会决定因素有关。 SCD 的情绪和压力相关影响会影响日常生活质量以及疼痛的频率和严重程度。探讨 SCD 患者的教育程度、就业状况和心理健康与疼痛发作频率和严重程度的关系。这是对美国镰状细胞病实施联盟 8 个地点接受治疗的患者在基线（2017-2018 年）收集的患者登记数据的横断面分析。数据分析于 2020 年 9 月至 2022 年 3 月进行。电子病历摘要和参与者调查提供了人口统计数据、心理健康诊断和成人镰状细胞生活质量测量信息系统疼痛评分。使用多变量回归来检查教育、就业和心理健康与主要结果（疼痛频率和疼痛严重程度）的关联。该研究共招募了 2264 名年龄在 15 至 45 岁之间的 SCD 参与者（平均 [SD] 年龄≥27.9 [7.9] 岁；1272 名女性参与者 [56.2%]）。近一半的参与者样本报告每天服用止痛药（1057 名参与者[47.0%]）和/或使用羟基脲（1091 名参与者[49.2%]），627 名参与者（28.0%）接受定期输血，457 名参与者（20.0%）通过医疗记录摘要确认抑郁症诊断，1789 名参与者（79.8%）报告严重疼痛（将最近的疼痛危机评为≥7 人（共 10 人），1078 人（47.8%）报告在过去 12 个月内有超过 4 次疼痛发作。样本的平均 (SD) 疼痛频率和严重程度 t 评分分别为 48.6 (11.4) 和 50.3 (10.1)。教育程度和收入与疼痛频率或严重程度的增加无关。失业（β， 2.13；95% CI，0.99至3.23；P < .001）和女性（β， 1.78；95% CI，0.80至2.76；P < .001）与疼痛频率增加相关。年龄小于 18 岁的年龄与疼痛频率 (β, −5.72; 95% CI, -7.72 至 -3.72; P < .001) 和疼痛严重程度 (β, 5.10; 95% CI, -6.70 至 -3.51; P < .001) 呈负相关。抑郁与疼痛频率增加相关（β， 2.18；95% CI，1.04 至 3.31；P < .001），但与疼痛严重程度无关。羟基脲的使用与疼痛严重程度增加相关（β， 1.36；95% CI，0.47至2.24；P = .003），每天使用止痛药与疼痛频率增加（β， 6.29；95% CI，5.28至7.31；P < .001）和疼痛严重程度增加相关（β， 2.87；95% CI，1.95 至 3.80；P < .001）。这些发现表明，就业状况、性别、年龄和抑郁症与 SCD 患者的疼痛频率相关。有必要对这些患者进行抑郁症筛查，尤其是那些疼痛频率和严重程度较高的患者。综合治疗和减轻疼痛必须考虑 SCD 患者的全部经历，包括对心理健康的影响。
What is the association of educational attainment, employment status, and mental health with pain episode frequency and severity among individuals with sickle cell disease (SCD)? In this cross-sectional analysis of 2264 individuals with SCD, 47.8% reported frequent pain (ie, ≥ 4 pain crises in 12 months). Although educational attainment and income were not significantly associated with increased pain episode frequency or severity, age, sex, and depression were associated with SCD-related pain. Pain is complex, and these findings suggest that screening patients with SCD for depression and other mental health challenges is warranted, especially among those experiencing higher pain episode frequency and severity. This cross-sectional study examines the associations of educational attainment, employment status, and mental health with pain episode frequency and severity among individuals with sickle cell disease. Pain related to sickle cell disease (SCD) is complex and associated with social determinants of health. Emotional and stress-related effects of SCD impact daily quality of life and the frequency and severity of pain. To explore the association of educational attainment, employment status, and mental health with pain episode frequency and severity among individuals with SCD. This is a cross-sectional analysis of patient registry data collected at baseline (2017-2018) from patients treated at 8 sites of the US Sickle Cell Disease Implementation Consortium. Data analysis was performed from September 2020 to March 2022. Electronic medical record abstraction and a participant survey provided demographic data, mental health diagnosis, and Adult Sickle Cell Quality of Life Measurement Information System pain scores. Multivariable regression was used to examine the associations of education, employment, and mental health with the main outcomes (pain frequency and pain severity). The study enrolled a total of 2264 participants aged 15 to 45 years (mean [SD] age, 27.9 [7.9] years; 1272 female participants [56.2%]) with SCD. Nearly one-half of the participant sample reported taking daily pain medication (1057 participants [47.0%]) and/or hydroxyurea use (1091 participants [49.2%]), 627 participants (28.0%) received regular blood transfusion, 457 (20.0%) had a depression diagnosis confirmed by medical record abstraction, 1789 (79.8%) reported severe pain (rated most recent pain crises as ≥7 out of 10), and 1078 (47.8%) reported more than 4 pain episodes in the prior 12 months. The mean (SD) pain frequency and severity t scores for the sample were 48.6 (11.4) and 50.3 (10.1), respectively. Educational attainment and income were not associated with increased pain frequency or severity. Unemployment (β, 2.13; 95% CI, 0.99 to 3.23; P < .001) and female sex (β, 1.78; 95% CI, 0.80 to 2.76; P < .001) were associated with increased pain frequency. Age younger than 18 years was inversely associated with pain frequency (β, −5.72; 95% CI, −7.72 to −3.72; P < .001) and pain severity (β, 5.10; 95% CI, −6.70 to −3.51; P < .001). Depression was associated with increased pain frequency (β, 2.18; 95% CI, 1.04 to 3.31; P < .001) but not pain severity. Hydroxyurea use was associated with increased pain severity (β, 1.36; 95% CI, 0.47 to 2.24; P = .003), and daily use of pain medication was associated with both increased pain frequency (β, 6.29; 95% CI, 5.28 to 7.31; P < .001) and pain severity (β, 2.87; 95% CI, 1.95 to 3.80; P < .001). These findings suggest that employment status, sex, age, and depression are associated with pain frequency among patients with SCD. Depression screening for these patients is warranted, especially among those experiencing higher pain frequency and severity. Comprehensive treatment and pain reduction must consider the full experiences of patients with SCD, including impacts on mental health.
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发表时间：
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影响因子：
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