ANXIETY AND DEPRESSION SCREENING IN ADULTS WITH SICKLE CELL DISEASE RECEIVING CARE IN THE BRAZILIAN PUBLIC HEALTH SYSTEM
Abstract
Sickle Cell Disease (SCD) is a genetic disorder with higher prevalence among black and mixed-race populations. The presence of pain and physical-functional, emotional, social, and occupational losses justifies studies investigating its biopsychosocial repercussions. Objective – To assess the prevalence of anxiety and depression among adults with SCD treated at a public referral hospital in Salvador, Bahia, Brazil. Materials and methods – 38 adults with SCD participated in this quantitative, descriptive, cross-sectional study conducted between May 2024 and January 2025. The clinical profile was established through detailed anamnesis, including sociodemographic characterization and application of the Hospital Anxiety and Depression Scale (HADS). Descriptive statistical analyses were performed using the R software. Results – Gender distribution was balanced, with a mean age of 33.5 years. Most participants were single (65.8%), black (55.3%) or mixed-race (42.1%), had completed secondary education (50%), and reported a monthly household income of up to one minimum wage (71.1%). Clinically, the predominant SCD genotypes were HbSS (71.1%) and HbSC (28.9%). All participants reported chronic pain. Borderline or suspected anxiety and depression were identified in 26.3% and 34.2%, respectively, and 31.6% received psychological follow-up. Additionally, 73.7% were physically inactive and 60.5% engaged in weekly leisure activities. Conclusion – Borderline scores for anxiety and depression suggest a high likelihood of these disorders in the studied population. These findings highlight the importance of mental health screening in SCD diagnosis and follow-up, contributing to scientific knowledge, improved clinical practice, and more effective public health policies.
Author Biographies
Doutora em Processos Interativos dos Órgãos e Sistemas, Universidade Federal da Bahia – UFBA, Professora da Escola Bahiana de Medicina e Saúde Pública – EBMSP e Estácio, Salvador, Bahia, Brasil.Â
Professor Titular de BioquÃmica, Programa de Pós-graduação Processos Interativos dos Órgãos e Sistemas, Universidade Federal da Bahia – UFBA.
References
1. Pauling L, Itano HA, Singer SJ, Wells IC. Sickle cell anemia, a molecular disease. Science. 1949;109(2835):443 DOI: https://doi.org/10.1126/science.110.2865.543
2. Ministério da Saúde (BR). Portaria conjunta nº 05, de 19 de fevereiro de 2018. Aprova o Protocolo ClÃnico e Diretrizes Terapêuticas da Doença Falciforme. BrasÃlia: Ministério da Saúde; 2018. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/sas/2018/poc0005_22_02_2018.html#:~:text=Aprova%20o%20Protocolo%20Cl%C3%ADnico%20e%20Diretrizes%20Terap%C3%AAuticas%20da%20Doen%C3%A7a%20Falciforme
3. Kavanagh PL, Fasipe TA, Wun T. Sickle cell disease: a review. JAMA. 2022;328(1):57-68 DOI: https://doi.org/10.1001/jama.2022.10233
4. O`Brien EC, Ali S, Chevassut T. Sickle cell disease: an update. Clin Med. 2022;22(3):218-20 DOI: https://doi.org/10.7861/clinmed.2022-0143
5. Connolly ME, Bills SE, Hardy SJ. Neurocognitive and psychological effects of persistent pain in pediatric sickle cell disease. Pediatr Blood Cancer. 2019;66(9):e27823 DOI: https://doi.org/10.1002/pbc.27823
6. Valrie C, Floyd A, Sisler I, Redding-Lallinger R, Fuh B. Depression and anxiety as moderators of the pain-social functioning relationship in youth with sickle cell disease. J Pain Res. 2020;13:729-736 DOI: https://doi.org/10.2147/JPR.S238115
7. Leite MM, Santos MEFD, Fernandes JVA, Geovanini DR, Soares FC, Fonseca TCC, et al. Depressão em pacientes com doença falciforme: uma revisão de literatura. Hematol Transfus Cell Ther. 2024;46:S1139 DOI: https://doi.org/10.1016/j.htct.2024.09.19915
8. Botega NJ, Bio MR, Zomignani MA, Garcia Jr C, Pereira WAB. Transtornos do humor em enfermaria de clÃnica médica e validação de escala de medida (HAD) de ansiedade e depressão. Rev Saúde Pública. 1995;29(5):359-63 DOI: https://doi.org/10.1590/S0034-89101995000500004
9. Oliveira LAB, Lopes TS, Sousa JN, Souza AC, Baptista AF, Pedrosa et al. Religiosity, anxiety, depression, and suicidal ideation in brazilian patients with sickle cell disease. Reflexus. 2023;17(2):277-90 DOI: https://doi.org/10.20890/reflexus.v17i2.2769
10. Mastandréa E, Lucchesi F, Kitayama MMG, Figueiredo MS, Citero VA. The relationship between genotype, psychiatric symptoms and quality of life in adult patients with sickle cell disease in São Paulo, Brazil: a cross-sectional study. Med J. 2015;133(5):421-27 DOI: https://doi.org/10.1590/1516-3180.2015.00171105
11. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70 DOI: https://doi.org/10.1111/j.1600-0447.1983.tb09716.x
12. Silva WS, Lopes TDSL, Reis DS, Barreto DPS, Silva GS, Oliveira TWS. Aspectos sociodemográficos e clÃnicos de pacientes com doenças falciformes dos centros de referência em Salvador, Bahia. BJHR. 2022;5(3):10526-39 DOI: https://doi.org/10.34119/bjhrv5n3-215
13. Castro MMC, Quarantini L, Batista-Neves S, Kraychete DC, Daltro C, Miranda-Scippa Â. Validade da escala hospitalar de ansiedade e depressão em pessoas com dor crônica. Rev Bras Anestesiol. 2006;56(5):470-7 DOI: https://doi.org/10.1590/S0034-70942006000500005
14. Osunkwo I, Manwani D, Kanter J. Current and novel therapies for the prevention of vaso-occlusive crisis in sickle cell disease. Ther Adv Hematol. 2020;11:2040620720955000 DOI: https://doi.org/10.1177/2040620720955000
15. Al Zahrani OS, Mukhtar O, Al Subaie M, Al Howiti WE. Systematic psychiatric assessment of patients with sickle cell disease. Saudi Med J. 2019;40(1):59-65 DOI: https://doi.org/10.15537/smj.2019.1.22919
16. R Core Team. R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria; 2024.
17. Kazak A, Ozkaraman A. The effect of progressive muscle relaxation exercises on pain on patients with sickle cell disease: randomized controlled study. Pain Manag Nurs. 2021;22(2):177-83 DOI: https://doi.org/10.1016/j.pmn.2020.02.069
18. Ohara DG, Ruas G, Castro SS, Martins PR, Walsh IA. Musculoskeletal pain, profile and quality of life of individuals with sickle cell disease. Rev Bras Fisioter. 2012;16(5):431-8 DOI: https://doi.org/10.1590/s1413-35552012005000043
19. Holdford D, Vendetti N, Sop DM, Johnson S, Smith WR. Indirect economic burden of sickle cell disease. Value Health. 2021;24(8):1095-101 DOI: https://doi.org/10.1016/j.jval.2021.02.014
20. Al-Marzouki AF, Alrefaie NI, Aljohani NA, Alandanusi RA, Alghamdi AA, Radhwi OO. The prevalence of depression and anxiety among sickle cell disease patients in King Abdulaziz University Hospital. Cureus. 2021;29;13(9):e18374 DOI: https://doi.org/10.7759/cureus.18374
21. Olowoselu FO, Uche E, Oyedeji OA, Enabulele O, Ogunnubi OP, Olowoselu OI, et al. Anxiety and depression in sickle cell anaemia: the impact of pain in a Nigerian population. Niger Hosp Pract. 2021;27(1-2):8-14. Available from: https://www.ajol.info/index.php/nhp/issue/view/19571
22. Levenson JL, McClish DK, Dahman BA, Bovbjerg VE, Citero VA, Penberthy LT, et al. Depression and anxiety in adults with sickle cell disease: the PiSCES project. Psychosom Med. 2008;70(2):192-6 DOI: https://doi.org/10.1097/PSY.0b013e31815ff5c5
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