Mind It: Increasing Rate of Mental Health Disorders in Hospitalized Sickle Cell Patients
Authors: Siddiqui Nauman , Godara Amandeep , Afzal Amber , Khan Mohammad Saud , Munigala Satish , Khan Marina , Khan Zubair , Tuncer Hande H. 
Published: October 2019

Abstract
Introduction:
The number of patients with sickle cell disease (SCD) approaches 100,000 in US after adjusting for early mortality (Hassell Am J Prev Med 2010). Management of SCD and its complications require frequent access to healthcare system lifelong, thus impacting patients' quality of life and cost of healthcare. Chronic pain inducing illnesses are known to increase susceptibility to mental health disorders (Rayner Pain 2016). Psychosocial disorders are common in this population and impact the course of hospitalization, however we have limited published data in this area. Hence, we performed a large retrospective study utilizing the National Inpatient Sample (NIS) data to evaluate the prevalence of mental health disorders in hospitalized sickle cell patients, and their influence on length of hospitalization.
Methods:
We identified hospitalized sickle cell patients using ICD 9 codes (282.5,282.6X -282.6X ) in the National Inpatient Sample (NIS) database. Similarly, ICD-9 codes were used to identify patients with mental health disorders of interest. The demographics and length of hospital stay of patients with and without mental health disorders were then compared.
Surveyfreq was used to calculate proportions and surveymeans was used to calculate median length of stay and hospital charges. Cochran-Armitage test was used for analyzing trends. We used chi-square for categorical data frequency, P value of < 0.05 was considered statistically significant. All analysis was performed using SAS 9.4.
Results:
We identified a total of 1,349,701 hospitalizations for sickle cell patients between 2003-2014, of which 221,279 (16%) had associated mental health disorders. Mood disorders were most common (40%), followed by substance abuse (28%) and anxiety disorder (16%) (Table 1). Over the timeline of our study, we found a longitudinal trend towards higher prevalence of mental health disorders in hospitalized sickle cell patients (Figure 1). There was higher prevalence of mental health disorders among patients aged between 21-40 years (24%). No difference in the rate of mental health disorders was noted in patients admitted with or without acute sickle cell pain episode. Median length of hospital stay (LOS) was 4 days in patients with mental health disorders (95% CI 4.04-4.12) compared to 3 days in those without (95% CI 3.17-3.20).
Conclusion: The prevalence of mental health disorders in hospitalized sickle cell patients has been gradually increasing from 2003 to 2014 and approaches 16% overall. The length of hospital stay is longer for the individuals with these disorders than those without hence, increasing the cost of health care and reducing patient satisfaction. Therefore, early recognition and intervention for mental health disorders is paramount to promote quality of life and reduce health care costs. This demands for a multidisciplinary approach to provide better access to mental health resources to this population in the outpatient setting.

Disclosures
No relevant conflicts of interest to declare.