DEPRESSION IN CHILDREN AND ADOLESCENTS WITH SICKLE-CELL DISEASE

Objective: To look at the role of a standardized screening test for as sessing depression in children and adolescents with and without sickle -cell disease and to compare findings with this instrument with clinic al evaluations by child psychiatrists. In addition, to suggest the pre valence of clinical depression in children and adolescents with sickle -cell disease. Design: Nonrandomized, sequential sample of subjects, c onvenience control sample, prevalence study using the Children's Depre ssion Rating Scale-Revised and an interview assessment by a child psyc hiatrist based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition. Setting: Comprehensive Sic kle Cell Center outpatient clinic and ambulatory Resident Practice Cli nic at the University of South Alabama Children's Medical Center, Mobi le. Study Participants: Patients aged 6 through 18 years with homozygo us sickle-cell disease (hemoglobin SS) sewed as study subjects. Subjec ts of the same age and race who did not have sickle-cell disease sewed as controls. Measurements and Results: The mean Children's Depression Rating Scale-Revised total scores were 27.1 and 22.1 in study and con trol groups, respectively (P=.0073). Eleven (29%) of 38 children in th e study group had scores indicating a high risk for clinical depressio n. Four (12%) of 34 children in the control group were in this categor y. The four items accounting for most of this significant difference w ere excessive fatigue, physical complaints, self-esteem, and morbid id eation. This contrasted with the clinical evaluation by a child psychi atrist in a clinical interview in which 13% of study subjects and 15% of control subjects had evidence of clinical depression (P=.85). Concl usion: Excessive fatigue and physical complaint factors contributed to a high false-positive rate when the Children's Depression Rating Scal e-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 ch ildren with sickle-cell disease compared with those without this chron ic illness.