Catastrophizing and Depression Are Associated With a Poorer Quality Of Life In Pediatric Patients With Sickle Cell Disease
Authors: Bakshi Nitya , Lukombo Ines , Shnol Helen , Mittal Nonita , Joshi Saumya Vinod , Belfer Inna , Krishnamurti Lakshmanan 
Published: October 2019

Abstract

Background
Depression and catastrophizing are critically important variables in understanding the experience of pain in patients with several types of chronic pain. In the PiSCES study, negative correlations were observed between high catastrophizing scores with greater depression and lower quality of life in adult patients with sickle cell disease (SCD). These psychological covariates have not been studied extensively in pediatric patients with SCD.

Methods
Patients entering a study of quantitative sensory testing (QST) completed baseline psychological covariates which included PROMIS measures of pain intensity, interference, anxiety, depression, sleep, fatigue and peer relationships. Participants also completed the Pain Catastrophizing Scale (PCS-child version, ©Sullivan MJ), Child Somatization Inventory (Walker L et al), Pediatric Pain Coping Inventory*(Varni JW et al) as well as Peds QL Generic*(Varni JW et al) and SCD specific*(Panepinto JA et al) measures of Quality of life. We performed a correlational analysis on psychological covariates with quality of life.

Results
A total of 24 patients were included in the study, however depression scores were missing in 2 patients and catastrophizing scores were missing in one patient.14 patients (58.3 %) had HbSS, 7 patients (29.1%) had HbSC and 3 patients (12.5%) had HbS-beta+ thalassemia. In the past 3 years prior to the study patients with HbSS experienced a median of 4 (IQR: 3-5), HbSC a median of 3(IQR: 0-9) and HbS-beta+thal a median of 7 (IQR: 3-13) vaso-occlusive crises (VOC). The median hemoglobin level was 10.4 (IQR: 8.8-11.1) for patients with HbSS, 13.3 (IQR: 11.3-13.5) for patients with HbSC and 12.2 (IQR: 11.6-13.3) for patients with HbS-beta+ thalassemia.
The median score on the Pain Catastrophizing scale was 29 (IQR: 13-35). The median total score on the Peds QL generic QoL scale was 74.4 (IQR: 57.05-87.01) and the SCD specific QoL was 61.9 (IQR: 50.65-77). The median depression score was 44.35 (IQR: 31.8-53.8) and median anxiety score was 46.15 (IQR: 35-51.8).
There was a significant negative correlation between catastrophizing on PCS and the total Peds QL SCD specific (Spearman’s rho= -0.57, p= 0.0043) and generic (Spearman’s rho= -0.41, p=0.047) quality of life scores. A similar significantly negative correlation was seen between the catastrophizing dimension score on the Pediatric Pain Coping Inventory with total scores on the Peds QL SCD specific (Spearman’s rho= -0.65, p=0.0006) and generic (Spearman’s rho= -0.59, p=0.002) quality of life scores. There was also a significant negative correlation between depression (on the PROMIS depression module) with SCD specific (Spearman’s rho= -0.58, p= 0.0046) and generic (Spearman’s rho=-0.71, p=0.0002) quality of life scores.
There was no correlation between catastrophizing (PedsQL Pediatric Pain Coping Inventory- Catastrophizing dimension or Pain Catastrophizing Scale) and healthcare utilization as measured by VOC requiring Emergency room visit or hospital admission over a 6 month, one year or three year period.

Conclusions
Children with SCD have a high median catastrophizing score. Catastrophizing and depression scales have a significant negative correlation with quality of life scores. Thus, pain, depression, and catastrophizing might all be important therapeutic targets in the comprehensive management of SCD in children.
*PedsQL™ contact information and permission to use: Mapi Research Trust, Lyon, France. E-mail: PROinformation@mapi-trust.org – Internet: www.Mapi-trust.org andhttp://www.pedsql.org/index.html

Disclosures:
No relevant conflicts of interest to declare.