The Prevalence of Depression and Anxiety Among Saudi Sickle Cell Disease Patients: A Systematic Review

Abstract

Abstract Title: The Prevalence of Depression and Anxiety Among Saudi Sickle Cell Disease Patients: A Systematic Review Background: Sickle cell disease (SCD) is known to have high prevalence in Saudi Arabia. A higher incidence of consanguinity marriages in Saudi Arabia is believed to be one of the reasons contributing to higher prevalence of SCD. SCD patients experience persistent hemolysis and vaso-occlusive crises. Advancements in the prevention and care of SCD changed the course and nature of the disease from a life� threatening condition to a chronic disease. Patients with SCD may develop a psychiatric illness due to SCD� related stress such as the unpredictability of SCD course and complications, reliance on hospital-based acute care, inadequately treated pain, and inconsistent or unpredictable interactions with the health care system. Furthermore, there is evidence of an association between chronic pain disorders and affective disorders. The presence of depression and anxiety in SCD patients can worsen the disease course and pain management. Therefore, screening and assessment of SCD psychological comorbidities has the potential to improve the course of the SCD. To our knowledge, there is no systematic review that assesses the prevalence of depression and anxiety in SCD patients in Saudi Arabia. Objective: This systematic review aimed to determine the prevalence of depression and anxiety in patients with sickle cell disease in Saudi Arabia and the factors that contribute to these conditions. Method: We conducted a literature search of records from five databases using a systematic review procedure based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies were considered eligible if the participants were primarily SCD patients and provided information on the prevalence of depression, anxiety, and depressive or anxiety symptoms. Result: We evaluated five studies with a total of 349 participants. Depression prevalence estimates ranged from 13% to 86%, whereas anxiety prevalence estimates ranged from 17.3% to 54%. Furthermore, in Saudi Arabia, painful episodes or vaso-occlusive crises (VOC), frequent outpatient visits, female gender, and poor income were found to be significant predictors of higher depression and/or anxiety prevalence in SCD patients. In addition, lower educational levels were linked to a higher prevalence of depression. In contrast, higher levels of education were associated to a higher prevalence of anxiety among Saudi Arabian SCD patients. Conclusion: Anxiety and depression were fairly common among SCD patients in Saudi Arabia. Improved depression and anxiety assessment methods in Saudi Arabia may help the mental health team in practice. Psychological assessment should be considered as part of routine SCD patient care to detect mental illness early, especially in high-risk individuals.