A concerted effort by health care and social service providers must include the patient's family and other people important in their social environment. Depression is often not appreciated in people with sickle cell disease. Low self-esteem commonly accompanies and exacerbates depression. The isolation can create a self-perpetuating scenario of low achievement and low expectations. Parenteral frustration is common, most often with adolescents and young adults.
Adolescence is a difficult time for many young people.
The stress of a chronic illness can produce conflicting tendencies. On one hand, the young person feels a need to assume control of his or her life. On the other, the prospect of facing the barriers created by sickle cell disease is daunting. Antisocial or self-destructive behavior can take a variety of forms. Missing clinic appointments often reflects an underlying ennui and sense of helplessness.