Depression among adolescents with Sickle cell anemia in Dar-es-salaam, Tanzania: prevalence, associated factors, and lived experiences

Abstract

ABSTRACT Background: Depression is a mood disorder that affects how a person feels, thinks, and conducts daily activities. Sickle Cell Anaemia (SCA), like other chronic diseases, has been associated with an increased likelihood of neuropsychiatric complications (including depression) and reduced quality of life due to the chronicity of the disease and the occurrence of painful crisis. Studies have revealed that adolescents with SCA are found to have higher rates of depressive symptoms compared to children who do not have SCA. Broad Objective: To assess the magnitude of depression, associated factors, and lived experiences among adolescents 10-19 years with SCA attending sickle cell clinic in Dar es salaam from October 2023 to March 2024. Materials and Methodology: A sequential dominance mixed method research study. Socio demographic and SCA severity data were collected using pre-structured and pre-tested questionnaires and in-depth interviews were conducted among participants with depression to explore their experiences. Descriptive statistics were summarized as mean and standard deviation for continuous variables. Categorical variables were described using frequencies and proportions with the difference in proportions analyzed using the chi-squared or Fisher's exact test, as appropriate. Univariate and multivariable analysis were used for the associated factors. A P-value of less than 0.05 was considered statistically significant. Qualitative data was analyzed using NVivo 11 pro; codes, themes and subthemes were derived and final write-up was made. Results: Among 326 adolescents, 216 (53.7 %) had depressive symptoms; where by 167 (38.7%) had mild symptoms, 48 (14.7 %) had moderate symptoms and 1 (0.3%) had severe symptoms. Fifteen percent of adolescents had clinical depression (moderate and severe depression). Various factors including age, gender, education level, health insurance, use of hydroxyurea, hospital admission, and blood transfusion showed no significant association with depression, p >0.05. Painful episodes experienced within previous 12 months were significantly associated with depression (aOR = 2.49) (95% CI: 1.17 - 5.29, p = 0.01). The majority of adolescents experienced loneliness and isolation and had not fully accepted the reality of living with SCA. Adaptive and maladaptive behaviors were observed as the coping mechanisms when depressed. Family and community social support was from parents, v friends and teachers. However, some reported mistrust from friends, bullying and name calling. Conclusion: Depression is common among adolescents with SCA in our setting. Painful episodes experienced by these adolescents were significantly associated with depression. Depressed adolescents commonly experienced loneliness and isolation. Social support, coping mechanisms, and acceptance play pivotal roles in their well-being. Understanding these experiences can inform targeted interventions and support systems for this vulnerable population Recommendations This study highlights the need for screening adolescents with SCA for depression and integration of mental health services in sickle cell clinics. Prevention and adequate management of frequent painful episodes is crucial for these adolescents. Targeted interventions should focus on good coping strategies, acceptance and strengthening social support systems