Prevalence of comorbid psychiatric illness and quality of life in adults with inherited bleeding disorders in central South Africa
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Date
2019-10
Authors
Koekemoer, Heinrich Tertius
Journal Title
Journal ISSN
Volume Title
Publisher
University of the Free State
Abstract
Introduction: Inherited bleeding disorders (IBDs) appear to be relatively uncommon, but they pose unique health-related challenges. IBDs are acquired through inheritance of mutations that cause abnormal bleeding. Due to their chronic nature, one would expect similar psychosocial problems as seen in other chronic diseases. The purpose of this study was to obtain information about the psychiatric comorbidities of patients with inherited bleeding disorders in order to be able to sensitize health workers and to promote holistic care in order to better patients’ health-related quality of life (HR-QoL). Aim: To achieve this, the researchers aimed to establish the prevalence of psychiatric comorbidities in patients with IBDs, as well as their QoL. Furthermore, risk factors associated with psychiatric comorbidity and HR-QoL were evaluated. Methods: A quantitative, cross-sectional, observational study was conducted using a questionnaire, the EQ-5D assessment tool, the Mini International Neuropsychiatric Interview - M.I.N.I. 7.0.2 (8/8/16 version), a functional assessment with the aid of the Functional Independence Score in Hemophilia (FISH) tool and also from patients’ clinical records. At the Bloemfontein and the Kimberley Haemophilia Treatment Centres respectively there were 57 and 12 adult patients who attended regularly. Forty adult patients were consecutively sampled from these two sites. Results: The median age of the sample was 29.5 years (range 18 to 65). The majority were male (83%), unemployed (75%), receiving a disability grant (53%) and had never been married (65%). The majority of patients had haemophilia (73%), followed by hereditary haemorrhagic telangiectasia (HHT) (23%), Von Willebrand Disease (VWD) (2.5%) and Bernard-Soulier syndrome (BSS) (2.5%). The prevalence of both hepatitis C virus (HCV) and human immunodeficiency virus (HIV) was 10%. Twenty-three percent of patients reported bleeding more than three times per month. The lifetime prevalence of comorbid psychiatric illness in patients with IBDs was high - 43% had one or more psychiatric comorbidity. Major depressive disorder (MDD) was particularly common, with a lifetime prevalence of 30%. The prevalence of anxiety disorders and substance use disorders were both 15%, followed by post-traumatic stress disorder (PTSD), schizophrenia and suicidality, all present in 2.5% of the sample. The group of patients with severe haemophilia carried most of the burden of psychiatric illness (53%) when compared to mild/moderate haemophilia, HHT and the other IBDs. The total sample had greater impairment in HR-QoL in all domains, but anxiety/depression compared to normative data. The severe haemophilia subgroup was the only subgroup with worse anxiety/depression when compared to normative data. The deficit in HR-QoL was more pronounced in all domains (except pain/discomfort) in the severe haemophilia group when compared to the mild/moderate group. Functional assessments showed that actions such as squatting, stair climbing, and running are the most severely affected domains of functionality. No significant risk factors could be established for the development of psychiatric illness, but patients with a higher level of education were less likely to develop a mental illness compared to patients with lower levels of education. Higher bleeding frequencies, as well as perceiving family as unsupportive were significant risk factors for impaired HR-QoL. Never having been married was associated with the development of psychiatric illness in the haemophilia subgroup. Conclusion: Patients with IBDs in central South Africa have a high prevalence of psychiatric illnesses, especially MDD (30%), compared to the 9.8% in the general population of South Africa. No demographic or clinical characteristics were associated with the development of psychiatric illness but optimizing measures to limit the bleeding frequency and educating and supporting family members might improve functioning and HR-QoL. Screening for comorbid psychiatric illness in patients with IBDs is recommended.
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Keywords
Dissertation (M.Med. (Psychiatry))--University of the Free State, 2019, Haemorrhagic disorders, Inherited blood coagulation disorders, Haemophilia, Hereditary haemorrhagic telangiectasia, Mental disorders, Health-related quality of life, Developing countries, Depression, Mini International Neuropsychiatric Interview (MINI)