Depression in Children and Adolescents With Sickle-Cell Disease

OBJECTIVE: To look at the role of a standardized screening test for assessing depression in children and adolescents with and without sickle-cell disease and to compare findings with this instrument with clinical evaluations by child psychiatrists. In addition, to suggest the prevalence of clinical depression in children and adolescents with sickle-cell disease. DESIGN: Nonrandomized, sequential sample of subjects, convenience control sample, prevalence study using the Children's Depression Rating Scale-Revised and an interview assessment by a child psychiatrist based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. SETTING: Comprehensive Sickle Cell Center outpatient clinic and ambulatory Resident Practice Clinic at the University of South Alabama Children's Medical Center, Mobile. STUDY PARTICIPANTS: Patients aged 6 through 18 years with homozygous sickle-cell disease (hemoglobin SS) served as study subjects. Subjects of the same age and race who did not have sickle-cell disease served as controls. MEASUREMENTS AND RESULTS: The mean Children's Depression Rating Scale-Revised total scores were 27.1 and 22.1 in study and control groups, respectively (P = .0073). Eleven (29%) of 38 children in the study group had scores indicating a high risk for clinical depression. Four (12%) of 34 children in the control group were in this category. The four items accounting for most of this significant difference were excessive fatigue, physical complaints, self-esteem, and morbid ideation. This contrasted with the clinical evaluation by a child psychiatrist in a clinical interview in which 13% of study subjects and 15% of control subjects had evidence of clinical depression (P = .85). CONCLUSION: Excessive fatigue and physical complaint factors contributed to a high false-positive rate when the Children's Depression Rating Scale-Revised was used to screen for depression among patients with sickle-cell disease. Based on the clinical interview by a child psychiatrist, the actual prevalence of clinical depression was not increased in children with sickle-cell disease compared with those without this chronic illness.