Depression and functioning in relation to health care use in sickle cell disease

The purpose of the current study was to investigate depression and health c are use in patients with sickle cell disease (SCD). Forty-four adults with SCD were interviewed and data from 43 participants, both with (n = 11) and without (n = 32) depression, were used for further analyses. Data from one potential subject were excluded on the basis of diagnosis. The full evaluat ion included the Structured Clinical interview for DSM-III-R Disorders (SCI D) and the Center for Epidemiologic Studies-Depression Scale (CES-D), as we ll as measures of psychosocial and behavioral functioning. Good between-ins trument agreement was found between the self-report and interview-based mea sures of depression. However the functioning data did not entirely support the use of a more stringent cutoff score on the CES-D. Findings suggest tha t the purpose of the evaluation should be factored into the decision-making process when determining which cutoff score should be utilized (i.e. what is the cost-benefit ratio for false-positives vs. false-negatives). A serie s of hierarchical regression analyses supported the finding that disease se verity alone does not explain the level of functioning displayed by patient s. More importantly, the patient's perceived functioning was the best indic ator of health care use within a 1-year period. Furthermore, specific inter ventions that target negative thinking and distorted cognitions, as well as provide psychoeducation, such as cognitive-behavioral therapy, need to be further explored within this population.