Depression and Anxiety in Thalassemia

By Monique Johnson

Depression and anxiety affect people all over the world, but are particularly prevalent in the United States with depression affecting approximately 6.7 percent and anxiety disorders about 18 percent of the United States population (Anxiety and Depression Association of America, 2010). Although depression and anxiety are well-recognized, it is still not clear to what extent these mental disorders affect those living with blood disorders such as thalassemia.

Depression is associated with a clustering of mood symptoms, negative thoughts, and somatic complaints that can persist for several weeks to several months. The major symptoms of depression are a depressed mood and loss of interest but the presentation of depression differs from person to person. There are many possible symptoms of depression that can be easily overlooked, particularly among chronic disease patients such as those living with thalassemia. Similarly, anxiety disorders are another category of mental illnesses that may affect chronic disease patients. An anxiety disorder differentiates from regular anxiety in that anxiety disorders can be associated with social and occupational dysfunction due to overwhelming feelings of panic, fear and worry. These symptoms may even include somatic symptoms such as cold chills, sweaty hands and increased muscle tension.

People with chronic illnesses may be more prone to symptoms of anxiety and depression compared to those without chronic illnesses. The day-to-day burden of managing a chronic condition and knowledge that the illness will be life-long may have an influence on the emotions of these patients. Thalassemia is a hereditary disease that requires long-term medical regimens, which may be very complicated. Disorders like, Thalassemia, can put an emotional pull on its patients and make them more vulnerable to mental illnesses like depression and anxiety.

Keskek, Kirim, Turhan, and Turhan (2013) examined the prevalence of depression in a sample of 53 patients with beta-thalassemia minor and 53 healthy controls. Their findings showed that depressive symptoms, assessed using Hamilton Depression Rating Scale (HDRS), were higher among patients with thalassemia than among the healthy control subjects. In fact, 32% of patients with thalassemia reported severe to very severe depressive symptoms compared to 1.9% in the control group. This data suggests that patients with thalassemia may be at greater risk for depression than their healthy counterparts.

Mednick et al., (2010) determined the prevalence of depressive and anxiety symptoms among 276 adolescent and adult participants with thalassemia enrolled in the Thalassemia Longitudinal Cohort. The ages of the participants ranged from 14 to 58. Thirty-three percent of participants reported experiencing symptoms of anxiety and 11% of participants indicated experiencing symptoms of depression. Patients who reported these anxiety or depression symptoms, were more likely to be women and older. These data suggests that at least 1 out of 10 patients with thalassemia may be experiencing depression or anxiety.

There is limited data on depression and anxiety among patients living with thalassemia. From the evidence reviewed above, patients with thalassemia report more depressive symptoms than their healthy counterparts. Research may find that difficulty in coping with a chronic illness, such as thalassemia, puts individuals at higher risk for depression and anxiety. It can be difficult to cope with the illness because, depending on the severity of the thalassemia, it may alter a person’s lifestyle and limit their mobility and independence. In turn, depression and anxiety can negatively impact a persons physical functioning. Understanding depression and anxiety in patients with thalassemia is crucial, not only to their psychological well-being but also to their physical health.
If psychological disorders in these patients are overlooked, then that allows for more harm and complications to their illnesses. By better understanding how patients with thalassemia experience and present symptoms of depression and anxiety, we may be able to identify these symptoms early and intervene. Addressing the psychological well being, in addition to the physical health of patients living with chronic diseases, may help improve the patient outcomes, quality of life and longevity.

Facts & Statistics | Anxiety and Depression Association of America, ADAA. (n.d.). Facts & Statistics | Anxiety and Depression Association of America, ADAA. Retrieved March 26, 2014, from http://www.adaa.org/about-adaa/press-room/facts-statistics

Keşkek, S. O., Kırım, S., Turhan, A., & Turhan, F. G. (2013). Depression in subjects with beta-thalassemia minor. Annals of Hematology, 92(12), 1611-1615.

Mednick, L., Neufeld, E. J., Kleinert, D. A., Xu, Y., Trachtenberg, F., Yu, S., et al. (2010). Symptoms of depression and anxiety in patients with thalassemia: Prevalence and correlates in the thalassemia longitudinal cohort. American Journal of Hematology, 85(10), 802-805.

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