The Prevalence of Mood and Alcohol Related Disorders within the Adult Sickle Cell Disease Population and Their Impact on Healthcare Utilization

Background:  Chronic pain, along with the other physical, emotional, and cognitive manifestations of Sickle Cell Disease (SCD) increases the risk of developing psychological disorders.  Studies with limited sample size have suggested that depression occurs at a significantly higher proportion in SCD patients than control groups.  In this study we assessed the burden of mood and alcohol dependence disorders in SCD adult patients and their effect on healthcare utilization using a nationwide sample.

Methods:  Inpatient and outpatient records in the Truven Health MarketScan®Database were used to calculate the prevalence of mental health disorders and hospital utilization in adult SCD patients who sought medical care during 2007 - 2012.  The prevalence of mental health disorders were compared to a nationwide sample of African Americans from the Collaborative Psychiatric Epidemiology Surveys (CPES, 2001 - 2003) database.

Results: Among 12,394 SCD patients with outpatient claims, the prevalence of mood disorders were 28% and 21% in females and males vs. 6% and 4% in 4,842 participants from the general African American population (all P <0.001).  SCD was associated with 4 and 2.5 times higher risk of alcohol use disorders in females and males (all P <0.001). Both types of diagnoses peak at older age (50-59 years) in SCD patients vs. the younger age group (19-29) in general African Americans. Among 44,000 hospital admissions with SCD diagnosis, 47% of patients with a mood disorder were readmitted within 30 days after discharge (OR = 1.48, P <0.001).   Mood disorders were associated with 0.5 days longer hospital stay (P <0.001). Neither mood nor alcohol related disorders were associated with higher cost of inpatient care.

Conclusion: The high burden of mental health disorders in SCD patients justify the need to include regular screening for mental health disorders for all SCD patients and the provision of early psychological intervention to remit or mitigate symptoms and prevent higher healthcare utilization.

Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number P50HL118006.  The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Figure 1. Prevalence of mood disorders in adult SCD patients who sought inpatient and outpatient medical care and the general African American population, by age.

Figure 2. Prevalence of alcohol related disorders in adult SCD patients who sought inpatient and outpatient medical care and the general African American population, by age.

Figure 3.  30-day readmission risk for SCD patients at the visit and user levels, 2007-2012.