Sickle Cell Anemia in Adults and the Prevalence and Influence of Concurrent Mental Illness - The Implementation of Routine Depression and Anxiety Screening

Sickle cell anemia is a complex disease process that contributes to a variety of medical complications related to hemolytic anemia and vaso-occlusion, causing significant health consequences from tissue ischemia and infarction. Depression and anxiety have been identified as common comorbidities contributing to an increase in healthcare utilization and costs. A diagnosis of major depression is also linked to elevated frequency and severity of pain. In the sickle cell disease (SCD) population, opioids are utilized as the primary treatment for the management of moderate-severe pain associated with their disease. Opioid use, however, has been linked to greater incidence of both depression and anxiety. Additionally, it has been identified that individuals with a diagnosis of both depression and chronic pain are more likely to use opioids even when their pain is controlled.

The US Preventive Service Task Force (USPTSF), CDC, and The American Society of Hematology (ASH) 2020 guidelines for sickle cell disease (SCD) recommend routine screening for depression and anxiety to assess patients for the presence of psychosocial health complications to identify individuals who may require social work, psychiatric, or case management referral. In the setting of an inner-city university hospital, there is no current policy endorsing routine depression and anxiety screenings within the sickle cell population experiencing vaso-occlusive event/episode (VOE).

This quality improvement project aims to increase in the number of patients screened for anxiety and depression and increase in the number of patients who screen positive and agree to mental health referral utilizing the PHQ-9 and GAD-7 screening tools. A team of six nurse practitioners will attend an educational PowerPoint session supporting the use of these screening tools to identify depression and anxiety as well as evidence describing the effects of SCD and comorbid mental health disorders. A pre- and post-screening intervention chart review will be conducted to compare outcomes, specifically if referrals were agreed to and placed. During this quality improvement (QI) project, data will be collected at weekly intervals for three months starting the day of project implementation and three months after the mental health screening intervention has been completed, for a total of six months. Scores will be calculated comparing pre- and post-intervention results, specifically the number of mental health screenings performed. Additionally, the number of mental health referrals placed will be counted. Anticipated outcomes include a statistically significant increase the number of patients screened for anxiety and depression utilizing the PHQ-9 and GAD-7 screening tools and an increase in the number of patients who agree to referral for the diagnosis if they test positive.