Mary Abrams

Sickle cell disease pain: relation of coping strategies to adjustment.

This study examines pain coping strategies in a relatively neglected pain population, sickle cell disease (SCD) patients. Seventy-nine patients diagnosed with SCD were given a structured interview to assess pain, activity level, and health care use during painful episodes. Patients also completed the SCL-90-R as an index of psychological distress and the Coping Strategies Questionnaire. Regression analyses controlled for age, sex, and disease severity measures. Results indicated that the coping strategies factors were important predictors of pain and adjustment. Individuals high on Negative Thinking and Passive Adherence had more severe pain, were less active and more distressed, and used more health care services. Individuals high on Coping Attempts were more active during painful episodes.

Stress, coping, and psychological adjustment of adults with sickle cell disease

A transactional model of psychological adjustment to chronic illness was examined with 109 African-American adults with sickle cell disease (SCD). Good psychological adjustment was associated with lower levels of perceived daily stress and stress regarding SCD illness tasks, higher efficacy expectations, less use of palliative coping methods, less use of negative thinking/passive adherence pain-coping strategies, and family functioning characterized by high levels of support and low levels of conflict and control. Overall the underlying stress and coping conceptual model accounted for 44-50% of the variance in psychological adjustment.

Sickle Cell Disease Pain: 2. Predicting Health Care Use and Activity Level at 9-Month Follow-Up

This study examined 9-month follow-up data obtained from adults with sickle cell disease (SCD) participating in a longitudinal study of pain-coping strategies. Of 99 subjects completing the baseline assessment of pain-coping strategies, 89 (90%) completed a structured pain interview assessing health care use and activity reduction during painful episodes over the follow-up period. Regression analyses controlling for demographics and disease severity revealed that baseline Negative Thinking and Passive Adherence was associated with greater activity reduction and more frequent health care contacts during the subsequent 9 months. Additional correlational analyses revealed that if levels of Negative Thinking and Passive Adherence increased from baseline to follow-up, this increase was associated with even further reductions in activity level during painful episodes. Changes in disease severity were not associated with any of the follow-up measures. Comparing pain-coping strategies assessed at baseline to pain-coping strategies measured at follow-up revealed that, without intervention, pain-coping strategies were relatively stable over time.

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 care 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 evaluation included the Structured Clinical Interview for DSM-III-R Disorders (SCID) and the Center for Epidemiologic Studies-Depression Scale (CES-D), as well as measures of psychosocial and behavioral functioning. Good between-instrument agreement was found between the self-report and interview-based measures of depression. However, the functioning data did not entirely support the use of a more stringent cutoff score on the CES-D. Findings suggest that 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 series of hierarchical regression analyses supported the finding that disease severity alone does not explain the level of functioning displayed by patients. More importantly, the patients perceived functioning was the best indicator of health care use within a 1-year period. Furthermore, specific interventions 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.

Depression, Suicidal Ideation, and Attempts in Black Patients With Sickle Cell Disease

There is a strong relationship between suicidal ideation, suicide attempts, and depression. Rates of successful suicides are relatively high among the chronically ill compared to other populations but are reduced with treatment. Depression and suicide rates also often differ among blacks as compared to other populations. Using survey methods, we evaluated self-reported rates of depression, suicidal ideation, and suicide attempts in 30 male and 37 female black patients with sickle cell disease (SCD). SCD is a condition characterized by chronic, unpredictable pains and psychosocial distress. Thirty-six percent of the sample self-reported depression in the past 30 days, while 22 percent of the sample exhibited scores on the Beck Depression Inventory indicative of mild or greater depression (mean BDI, 8.31 +/- 7.79). Twenty-nine percent of patients indicated an episode of suicidal ideation and 8%, a suicidal attempt in their lifetime. Thirty-three percent reported treatment by a mental health professional. We conclude that there is a continuing need for mental health services in the management of depressed affect and risk for suicide among patients with SCD. Standards of clinical care must remain flexible to accommodate the mental health needs of this population of patients.

Experimental pain sensitivity and reports of negative thoughts in adults with sickle cell disease

Studies have found that reports of negative thoughts are significant predictors of pain report, health care use, and psychosocial adjustment in adults with sickle cell disease (SCD); however, the mechanisms of the relationship are not clear. In this study, 58 adults with SCD completed an experimental pain induction task (finger pressure). Sensory decision analyses determined sensory discrimination (the ability to discriminate lower and higher intensities) and response bias (the tendency to readily report pain during noxious stimulation). Hierarchical regression analyses controlling for subject gender and acute disease status indicated that individuals who reported more negative thoughts had a greater tendency to report pain during noxious stimulation even to stimuli of relatively low intensity. Reports of negative thoughts were unrelated to sensory discrimination, suggesting that motivational and attitudinal factors, rather than sensory factors, were involved. Clinical implications for health care providers who treat patients with severe SCD pain are discussed.

Pain drawings and sickle cell disease pain

This study examined the relationship of pain drawings to somatization in patients with sickle cell disease (SCD). Sixty-nine adult patients with SCD completed a pain drawing in which they shaded in areas of the body in which they experienced pain and also completed the symptom checklist (SCI) 90-R as an index of psychological distress. Analysis of variance indicated that patients who were categorized as having pain drawings with sites inconsistent with expected SCD pain patterns had somatization scores in the clinically significant range. The results suggest that health care professionals who treat SCD patients need to consider pain patterns. In individuals with pain patterns atypical for SCD, the psychological status of the patient may need to he evaluated to facilitate optimal pain management.

Psychological adjustment of adults with sickle cell anemia: Stability over 20 months, correlates, and predictors

The stability of psychological adjustment was assessed across three time points spanning a 20-month period with 59 African-American adults with sickle cell anemia. Stable good adjustment was associated with lower levels of daily and illness-related stress, palliative methods of coping with stress, and pain coping strategies characterized by negative thinking/passive adherence. With baseline levels of illness and demographic parameters controlled, baseline levels of daily and illness-related stress made significant independent contributions to adjustment at 20 months follow-up. The findings are discussed in relation to the potential utility of improving methods of coping with stress and pain to enhance the adjustment of patients with sickle cell anemia.

Observation of pain behaviors during episodes of sickle cell disease pain

ObjectiveTo assess the utility of a brief behavioral observation method to quantify pain. DesignCorrelational study. Patients31 sickle cell disease (SCD) patients first seen in an outpatient clinic in painful crisis. Outcome MeasuresObserved pain behaviors, physician rating of patient pain on a 0 to 10 scale, patient rating of pain on a 0 to 10 scale, and patient pain report from the McGill Pain Questionnaire. ResultsHigh interrater reliability for the brief behavioral observation was found, and observed pain behavior was found to correlate significantly with physician ratings of pain. ConclusionsThis study is an important first step toward developing a systematic behavior-observation methodology for the analysis of SCD pain. The current methodology was found to be reliable and easily implemented in a busy, outpatient clinic.

Neuropsychological assessment, neuroimaging, and neuropsychiatric evaluation in pediatric and adult patients with sickle cell disease (SCD)

Traditionally, neuropsychological deficits due to Sickle Cell Disease (SCD) have been understudied in adults. We have begun to suspect, however, that symptomatic and asymptomatic Cerebrovascular Events (CVE) may account for an alarming number of deficits in this population. In the current brief review, we critically evaluated the pediatric and adult literatures on the neurocognitive effects of SCD. We highlighted the studies that have been published on this topic and posit that early detection of CVE via neurocognitive testing, neuropsychiatric evaluations, and neuroimaging may significantly reduce adult cognitive and functional morbidities.