Evaluating Self vs. Interviewer-Administered Screening for Anxiety in Sickle Cell Disease
Authors: Collins Cameron R , Schnell Patrick , Cronin Robert 
Published: June 2024

Abstract

Presentation Date: 6/9/2024
Presentation Start Time: 3:45:00 PM

Background
Sickle Cell Disease (SCD) is a group of inherited red blood cell disorders that affects approximately 100,000 adults in the United States alone. While most SCD research focuses on depression, other psychiatric disorders, such as generalized anxiety, are understudied yet common in adults with SCD. New national guidelines published in 2023 recommend screening adults 64 and younger for anxiety disorders. Anxiety can also lead to an adverse effect on the quality of life, healthcare utilization, and clinical course of people with SCD. Hence, it may be essential to screen patients with SCD for anxiety, as it has the potential to impact the course of the disease negatively. Utilizing diagnostic tools, such as General Anxiety Disorder-7 (GAD-7), enables anxiety screening in patients. The GAD-7 can be completed via self-administration by the patient or by someone else, such as a nurse or healthcare provider asking the questions. In this study, we evaluated discrepancies in anxiety scores from these modes of administration of the GAD-7.

Objective
This study aimed to evaluate differences in GAD-7 scores based on the administration method the screening tool was completed. We hypothesized that patients self-administering the GAD-7 would result in more positive anxiety screenings compared to clinic nurses administering the questionnaire during visits.

Methods
This research was conducted as part of an integrated primary care provider medical home at the Ohio State University Wexner Medical Center Comprehensive Sickle Cell Clinic. Between January 1, 2021, and June 25, 2023, adults with Sickle Cell Disease (SCD) were recruited to participate. Participants were asked to complete the GAD-7 questionnaire on tablets independently and were assessed by nursing staff on the same day. Anxiety levels were categorized as mild (≥5), moderate (≥10), and severe (≥15) based on scores. Participants who did not complete self-administered and interviewer-administered GAD-7 assessments on the same day were excluded from the analysis. Statistical analysis was conducted using Welch’s t-test of independence to compare results between self-administration and interviewer-administration. In addition, a McNemars test was employed to compare the rates of positive anxiety screening between the two administration methods. The Ohio State University Institutional Review Board (IRB) approved the study.

Results
A total of 34 adults with SCD between the ages of 18-61 were included in the statistical analysis. Of these participants, 58.8% were female, 32% had hemoglobin SC, 59% had hemoglobin SS, 6% had hemoglobin Sbeta+, and 3% were unreported. Participants had a mean age of 31.9 years and a standard deviation of 10.9 years. Almost all participants, excluding one, completed the self-administered GAD-7 first and then were given the interview-administered screening. The rate of positive anxiety screening (GAD-7 ≥5) was higher with self-administered GAD-7 (38%) compared to interviewer-administered (12%, p = 0.016). The mean GAD-7 scores were higher with self-administered (mean: 3.47, SD: 3.82) as compared to the interviewer-administered (mean 1.5, SD: 2.21),= p &lt; 0.001). More participants reported a higher severity of anxiety via self-administration vs. interviewer-administration (Table 1).

Conclusions
GAD-7 scores were notably higher, and significantly more adults with SCD screened positive using the self-administered vs. the interviewer-administered GAD-7 screening. Interviewer-administered anxiety screening may result in underdiagnosed anxiety and adversely affect patient quality of life, disease course, and clinical outcomes. Understanding the relationship between anxiety and SCD can help healthcare providers develop more comprehensive and personalized care plans for individuals living with this chronic condition. This study was limited to a single center and a selection bias of only patients reporting to the SCD clinic. Future multi-centered studies are needed to compare and improve our understanding of how to screen, diagnose, and manage anxiety in SCD optimally. By holistically addressing anxiety, we can improve overall patient outcomes and enhance the quality of life for individuals with SCD.