Methods
This is a cross-sectional single center study conducted at Marmara
University Medical Faculty, Division of Pediatric Pulmonology Selim
Çöremen CF Center between May 2019 and July 2019.
Participants were asked to complete the PHQ-9 and GAD-7 questionnaires
to evaluate the level of their depression and anxiety at the outpatient
clinic during routine follow-up visit. Patients with a definitive
diagnosis of CF were eligible. Consecutive sampling method was used and
all patients who came to the outpatient clinic during the study period
were involved into the study.
The objectives of this study are to measure depression and anxiety
levels of patients and their caregivers and to determine the risk
factors affecting these levels. Patients’ signs and symptoms were noted
before the questionnaires were done. Necessary information for
evaluation of the clinical status of the patient and adherence to
medical treatment/airway clearance were collected from medical records.
Adherence was assessed by patient/parent self-reports. Patients’ age,
age at the time of diagnosis, anthropometric measurements, mutations,
forced expiratory volume in one second (FEV1) %, treatment and
pulmonary physiotherapy regimens, past medical history (allergic
bronchopulmonary aspergillosis, pneumothorax, hemoptysis, number of
hospital admissions and exacerbations, sputum colonization history) and
co-morbidities were noted for analysis. CF disease severity was
classified as mild if the FEV1 was more than 70%, as moderate if the
FEV1 was between 40% and 69.9%, and as severe if the FEV1 was 39.9%
or below of the predicted value.
For the assessment of anxiety and depression, participants were asked to
complete the validated Turkish versions of 9-item Patient Health
Questionnaire Depression Scale (PHQ-9) and 7-Item Generalized Anxiety
Disorder Scale (GAD-7)10. The PHQ-9 is composed of
nine depressive symptom items listed in the Diagnostic and Statistical
Manual of Mental Disorders-4th edition (DSMIV) for depression. Patients
were asked to rate the extent of their symptoms that had bothered them
during the previous 2 weeks using a 4-point Likert rating scale. The
PHQ-9 severity score ranges from 0 to 27. Patients achieving a score
equal or above 15 are regarded as suffering from at least minor
depression 11.The GAD-7 is a tool to assess general
anxiety disorder and it is comprised of seven items representing the
DSM-IV symptom criteria for GAD (e.g., “Feeling nervous, anxious or on
edge”).
Patients were asked to indicate how often, during the last 2 weeks, they
were bothered by each symptom, using a 4-point Likert-type rating scale.
Total test scores range from zero to 21 with a score of eight deemed
sufficient to identify symptoms of general anxiety disorder, panic
disorder, post-traumatic stress disorder or social anxiety disorder12. The internal consistency reliability of the
Turkish version of the GAD-7 (Cronbach’s α = 0.85) and the test–retest
reliability (intraclass correlation = 0.83) were reported to be good12; 13.
The aim of the study was explained and informed consent was obtained
from the participants beforehand. The Marmara University Medical Faculty
Research Ethics Committee had approved the study, protocol number
09.2020.510.
Statistical analysis
Data were analyzed using the Statistical Program for Social Sciences
(SPSS for IBM, 21.0). Descriptive statistics are presented in numbers,
mean and standard deviations. The normal distribution of continuous
variables was evaluated using the Shapiro‐Wilk test. The Mann–Whitney U
test was used for group comparison and the Spearman’s rho correlation
coefficient to assess relationships. p < 0.05 was used for
statistical significance.