Background: Screening for internalizing symptoms of anxiety and depression is recommended as standard of care for persons with bleeding disorders (PwBD). Internalizing symptoms have been connected to PwBD joint-related pain, adherence to bleeding disorder (BD) management, and higher utilization of medical system for BD-related events. Recent attention has also been paid to the impact of trauma on PwBD and the role social determinants of health have on impacting PwBD access to and engagement in their BD medical care. To examine the associations between PwBD psychological symptoms, BD-related markers of health, and social determinants of health, we present a pragmatic analysis of clinical data from a sample of patients using retrospective chart review and publicly available survey data (i.e., American Community Survey).
Methods and Analysis: Our sample includes 309 screenings of psychological symptoms (depression, anxiety, and trauma) taken from clinical records of 273 adult PwBD (42% female; 22% nonwhite; Mage = 40 (15.77), ages ranging from 18-86) attending appointments for multidisciplinary bleeding disorder management. Psychological screening was provided as part of standard of care.
Results: PHQ-9 scores were predicted from age, F(1) = 5.81 , p = .02 ; joint health F(1) = 6.30 , p = .01; and mental health history F(1) = 15.93, p = .0001.The squared multiple correlation for a regression that included all clinical and social variables of interest was .35, and yielded a significant prediction of PHQ-9, F(24, 93) = 2.07, p = .007 However, similar models did not significantly predict GAD-7 scores or trauma symptoms, although mental health history was a significant predictor of both (GAD-7, F(1) = 9.13, p = .003; trauma, F(1) = 10.34, p = .002).
Conclusions/Implications/Limitations: Results supported previous findings connecting joint health and depression for PwBD. Limitations include the use of retrospective and self-report methodologies. Further, we limited our analyses to adult participants. We anticipate earlier assessment of psychological symptoms and SDOH impacting barriers to accessing and engaging in healthcare in pediatric samples may provide opportunities to reduce their impact and lead to improved BD health outcomes and quality of life.