Prevalence of mental health issues among those with CF

A systematic review and meta-analysis by Monash University, which looked at the prevalence of mental health issues in people with cystic fibrosis (CF) and their carers reveals that anxiety and depression are common here, with mental health issues transcending all age groups.

According to the review anxiety in children with CF is 26% higher than in the general paediatric population, and depression in adults with CF is 27% higher.

Carers of people with CF also had significantly higher rates of both depression and anxiety compared to the global prevalence of both illnesses.

However, the review, which only included studies where a psychometric tool (PT) to specifically assess depression and anxiety was used, also showed that the choice of PT significantly influenced prevalence, indicating a need for future studies to use the optimal PT for each CF population to allow appropriate interpretation and identify those most at risk.

“Our review looked at 94 articles and over 18,000 people with CF worldwide, showing depression and anxiety to be consistently high across all age groups,” the study’s first author Monash Health pharmacist and PhD candidate at Monash’s Centre for Medicine Use and Safety, Louise Lord said.

“However, sub-analysis revealed that the PT used to describe prevalence led to a number of gaps, such as a sparsity of information involving children under 12 with cystic fibrosis, as those in this age group were understudied.”

It’s said that PTs are tools used to assess various individual factors that may predict behaviours and outcomes in various circumstances, including diseases such as cystic fibrosis.

Ms Lord said that the study found that the optimal choice of PT is one that is validated in the CF population and which is recommended by the International Committee on Mental Health in Cystic Fibrosis consensus statements published in 2016.

“The review found that the choice of PT in each study impacted results substantially, emphasising the need for clinicians to be aware of the validity each tool has in the CF population, and in different age groups,” she said.

“For example, the tools that have been validated for depression or anxiety screening in people living with cystic fibrosis include the Patient Health Questionnaire for depression and Generalised Anxiety Disorder 7-item measure for anxiety.

“While there were guidelines for those aged 12 and over with cystic fibrosis, the optimal choice of psychometric tool in those younger than this could not be determined, leading us to conclude that there is still much work to be done to help identify those most at risk, particularly for children under 12 who could be slipping through the gaps,” she said.

There are an estimated 3500-4000 people in Australia living with cystic fibrosis.

The psychological burden, such as depression and anxiety, can result in poorer outcomes such as decreased lung function, more hospitalisations and higher healthcare costs.

The mental health of carers can also affect the outcomes of people with cystic fibrosis.

“New treatments, such as the recently Pharmaceutical Benefits Scheme (PBS) listed elexacaftor/tezacaftor/ivacaftor (Trikafta®), are allowing people with cystic fibrosis to live longer lives, so it is imperative that the quality of life is also optimised,” Ms Lord said.

The review confirms the need for regular screening measures using appropriate psychometric tools.

Future research in this area should help identify those at most risk, as well as focussing on identifying the most appropriate tools for children under 12 years of age.

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