EARLY-LIFE PAIN EXPERIENCES AND DEPRESSION ONSET AMONG CHILDREN WITH SICKLE CELL DISEASE A LONGITUDINAL ANALYSIS USING TEXAS MEDICAID DATA
Author(s)
Hyeun Ah KANG, MEd, MS, RPh, PhD1, Mrinmayee Lakkad, MS PhD1, Desiree R. Azizoddin, Psy D2, Taehyung Kim, MS1.
1Health Outcomes Division, The University of Texas at Austin, Austin, TX, USA, 2Department of Supportive Oncology, Dana Farber Cancer Institute, Boston, MA, USA.
1Health Outcomes Division, The University of Texas at Austin, Austin, TX, USA, 2Department of Supportive Oncology, Dana Farber Cancer Institute, Boston, MA, USA.
OBJECTIVES: Children with sickle cell disease (SCD) often experience severe pain episodes, such as vaso occlusive crisis (VOC), as early as 6 months old. While prevalent, the impact of early-life pain experiences and the subsequent onset of depression remains unknown. This study aimed to assess the association between SCD-related pain episodes during childhood and subsequent depression risk.
METHODS: This retrospective cohort study used Texas Medicaid data (01/2016 - 08/2024). Eligible patients were aged 2-18 years, had ≥3 non-drug SCD claims within 5 years, no pre-index depression or post-index non-SCD pain, and continuous enrollment during a 12-month pre-index period. For the exposed group, the index date was the first emergency department (ED) visit or inpatient admission for SCD-related pain (VOC or acute chest syndrome) between 01/2017-08/2023; unexposed patients received a proxy index date using the difference between exposed group’s SCD diagnosis and pain diagnosis dates. Follow-up continued until depression diagnosis, disenrollment, or study end. Time to depression onset was assessed using Kaplan-Meier curves and Cox Proportional Hazards regression, adjusting for age, sex, baseline mental health disorder, learning disability, ED visits, and Charlson comorbidity index (CCI).
RESULTS: Among 893 patients (mean age=8.2[4.9] years; 46.7% female), 705 (79.95%) experienced SCD-related pain and 188 (21.05%) did not. During follow-up, 23 (3.3%) of the exposed group developed incident depression (median follow-up: 5.0 years) compared to 5 (2.7%) in the unexposed group (median follow-up: 4.7 years). There was no significant difference in depression onset between the two groups (adj HR=1.26, 95% CI:0.47-3.37, p=0.65) after adjusting for covariates. Higher depression risk was associated with older age, female sex, and baseline mental health conditions.
CONCLUSIONS: Early SCD-related pain was not significantly associated with subsequent depression onset, suggesting a limited role as an independent risk factor. Early mental health screening and targeted intervention is essential for this population.
METHODS: This retrospective cohort study used Texas Medicaid data (01/2016 - 08/2024). Eligible patients were aged 2-18 years, had ≥3 non-drug SCD claims within 5 years, no pre-index depression or post-index non-SCD pain, and continuous enrollment during a 12-month pre-index period. For the exposed group, the index date was the first emergency department (ED) visit or inpatient admission for SCD-related pain (VOC or acute chest syndrome) between 01/2017-08/2023; unexposed patients received a proxy index date using the difference between exposed group’s SCD diagnosis and pain diagnosis dates. Follow-up continued until depression diagnosis, disenrollment, or study end. Time to depression onset was assessed using Kaplan-Meier curves and Cox Proportional Hazards regression, adjusting for age, sex, baseline mental health disorder, learning disability, ED visits, and Charlson comorbidity index (CCI).
RESULTS: Among 893 patients (mean age=8.2[4.9] years; 46.7% female), 705 (79.95%) experienced SCD-related pain and 188 (21.05%) did not. During follow-up, 23 (3.3%) of the exposed group developed incident depression (median follow-up: 5.0 years) compared to 5 (2.7%) in the unexposed group (median follow-up: 4.7 years). There was no significant difference in depression onset between the two groups (adj HR=1.26, 95% CI:0.47-3.37, p=0.65) after adjusting for covariates. Higher depression risk was associated with older age, female sex, and baseline mental health conditions.
CONCLUSIONS: Early SCD-related pain was not significantly associated with subsequent depression onset, suggesting a limited role as an independent risk factor. Early mental health screening and targeted intervention is essential for this population.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
SA8
Topic
Study Approaches
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Pediatrics, SDC: Rare & Orphan Diseases