Cerebrovascular Accidents are Associated With Increased Rates of Anxiety and Depression in People With Sickle Cell Disease: A National Database Study

BACKGROUND: Anxiety and depression are common yet often underrecognized comorbidities in people with sickle cell disease (PwSCD), contributing to poor quality of life and adverse health outcomes. However, few large-scale studies have examined whether cerebrovascular accident (CVA)-a major complication of SCD-is associated with higher rates of anxiety and depression. Understanding this relationship is essential to inform early screening and comprehensive, multidisciplinary care for PwSCD. METHODS: This retrospective cohort study utilized the Epic Cosmos database, which includes over 200 million patients from 1118 US health systems (January 2003-December 2022). Cases were defined as PwSCD aged 0-110 years with a documented history of CVA; controls were PwSCD without CVA. Depression and anxiety were identified using ICD-10 diagnostic codes. Rates between groups were compared using chi-square tests with Yates' correction and Bonferroni adjustment (p ≤ 0.0083). RESULTS: Among 130,148 PwSCD, 9,306 (7.1%) had a history of CVA. Anxiety and depression were significantly more prevalent in PwSCD with CVA (36.4% and 39.7%) than those without (18.3% and 22.0%; p < 0.0083). Females with CVA had higher rates of both conditions (42.3% and 46.2%) than males (28.5% and 30.9%). The largest proportion of patients with anxiety and depression was in the 50-64-year age group. CONCLUSION: PwSCD with a history of CVA are nearly twice as likely to have anxiety and depression as those without. These findings underscore the need for routine anxiety and depression screening and integration of psychosocial care into comprehensive SCD management to improve long-term outcomes and quality of life.