Introduction
Cystic fibrosis (CF) is the most common autosomal recessive disease that leads to early mortality in Caucasians worldwide 1. The disease is highly burdensome with progressive multisystem involvement, mostly problematic due to persistent lung infections, frequent hospitalizations and time consuming treatment regimens taking 2 to 4 hours per day in average 1; 2. Numerous studies indicate that children and adults with chronic illnesses, as well as parent caregivers, are at increased risk for psychological difficulties .
The largest psychological screening study conducted on CF, The International Depression Epidemiological Study (TIDES), shows that rates of depression among patients are two times and parents of children with CF are 2-3 times higher than rates of depression in broad community samples 4. Psychological distress in individuals with CF has been associated with: worse health outcomes (e.g., decreased lung function, lower BMI), worse adherence, worse quality of life, increased exacerbations, hospitalizations, and health-care costs5-8. With these facts, The International Committee on Mental Health in Cystic Fibrosis (ICMH) developed consensus statements for screening and treating depression and anxiety in individuals with CF and their caregivers. The CF Foundation and European Cystic Fibrosis Society (ECFC) recommend 9-item Patient Health Questionnaire Depression Scale (PHQ-9) and 7-Item Generalized Anxiety Disorder Scale (GAD-7) for screening 9.
Despite evidence in the TIDES study that a new diagnosis of CF-related diabetes, and events such as hemoptysis and pneumothorax, may precede elevations in symptoms of depression and anxiety, little is also known about the ‘triggers’ of psychological symptoms, or how mood affects health outcomes in this complex disease. Therefore, ICMH suggested further studies to identify psychosocial and clinical risk factors of depression and anxiety in CF patients and their caregivers9.
In the present study, we aimed to assess the prevalence of depression and anxiety in CF patients and parent caregivers along with identifying possible risk factors.