Longitudinal mental health trends in pediatric cystic fibrosis

ABSTRACT

Background: People with cystic fibrosis (CF) are more likely to have anxiety and depression symptoms than the general population, with psychological distress being associated with negative health outcomes. The Cincinnati Children's Hospital Medical Center CF Center has been screening people with CF aged 12 and older since 2016 for anxiety and depressive symptoms. Little is known about longitudinal mental health trends for youth with CF, especially during the COVID-19 pandemic. Method(s) Chart review was conducted for individuals aged 12 and older seen for routine care at our center with at least one General Anxiety Disorder (GAD-7) or Patient Health Questionnaire (PHQ-9) screening result between January 2016 and December 2021. Data included demographic characteristics;dates and scores of GAD-7 and PHQ-9;mental health encounters 12 months before each screening date;and clinical variables of disease severity, including percentage predicted forced expiratory volume in 1 second (FEV1pp), body mass index, CF-related diabetes (CFRD), antibiotics in the 28 days prior, and exacerbations in the 12 months prior. Descriptive statistics were used to summarize demographic variables, logistic regression and linear mixed modeling were used to identify predictive relationships, and t-testswere used to compare impact of COVID with that of prior years. Result(s) The sample included 150 individuals with at least one screen across the 6 years. An average of 83 people completed at least one GAD-7 or PHQ-9 in each year. Across the 6-year time period, the percentage of individuals with low scores increased, and the percentage of people with moderate to severe scores was stable (Figure 1). Approximately 35% of individuals were rescreened at least once in a given year because of a previously high symptom score. For thosewho screened in the moderate to severe range (>=10) on initial screens per year, an average of 32% (GAD-7) and 37% (PHQ-9) had a lower score (<10) on their second screen per year. Individuals who scored 10 or higher on initial GAD-7 or PHQ-9 screens in any year were statistically more likely to have a CFRD diagnosis ( p = 0.02, GAD-7;p = 0.02, PHQ-9) and more psychology or psychiatry visits 12 months before the screening date ( p < 0.01, GAD-7;p < 0.01, PHQ-9) than those with minimal scores. In addition, PHQ-9 scores of 10 or greater were significantly associated with lower FEV1pp than low scores. Adherence to screening protocols consistently increased over time. Of all eligible individuals, 56% completed a GAD-7 and 55% a PHQ-9 in 2016, increasing to 92% and 94%, respectively, by 2021, despite the impact of the COVID-19 pandemic on CF care visit frequency. GAD-7 scores were not significantly different before COVID and during COVID ( p = 0.06);PHQ-9 scores were higher before than during COVID ( p = 0.02) despite similar numbers of screens conducted per year. (Figure Presented)Figure 1. Percentage of initial Patient Health Questionnaire (PHQ-9) and General Anxiety Disorder (GAD-7) scores per year from 2016 to 2021 of people with cystic fibrosis seen at Cincinnati Children's Hospital Medical Center Conclusion(s) These longitudinal trends in mental health symptom scores over time are reassuring,with increasing frequency of lowscores and stable moderate to severe scores. This may be because of greater awareness of mental health symptoms, more interventions through care teams, or improved access to resources. Similarly, although general population data suggest worsening of anxiety and depressive symptoms during the COVID- 19 pandemic, we hypothesize thatwewere able to buffer the impact of the pandemic on mental health in our center by screening and responding to screens. These results highlight the importance of consistent monitoring and support for mental health symptoms in people with CFCopyright © 2022, European Cystic Fibrosis Society. All rights reserved