Oral Papers: Medical Specialties II: Pulmonology, Infectious Disease
About 30,000 U.S. residents have cystic fibrosis (CF), and C-L psychiatrists are often requested to see these patients.1 Compared with the general population, rates of anxiety or depression are 2-3 times higher; elevated rates of depression, anxiety, and suicidal ideation are reported among inpatients.1-2 Our study aims to increase knowledge of the psychological characteristics – including self-esteem, fear, and risky behaviors – of this cohort.
Our IRB approved recruitment of 30 participants. Subjects are individuals with CF, ages 11-22 years. A questionnaire comprising Likert scales (range: “strongly agree” – "strongly disagree”), one binary, and one fill-in response were completed. Domains assessed include self-esteem, risky behaviors, relationships, and fears. Data from anonymized questionnaires were analyzed.
Thirty subjects (19 females, 11 males; mean age, 16.8 ± 3.3 years) completed the study. Concerning fear about the future, 80% (n=24) of responses ranged from “agree” – “disagree.” Regarding fear about health, 70% of responses ranged from “neither agree nor disagree” – “strongly agree” and 6.7% “strongly disagreed” they were fearful about health. Eighty-three percent “agreed” or “strongly agreed” they followed doctor’s recommendations. Concerning current tobacco and illicit substances use, 97% – 87% responded “never;” 70% reported using alcohol less than monthly or never. Eighty-seven percent reported fights with parents “once to twice per week” or “never.” Self-esteem responses suggest most subjects like their appearance and themselves (90% and 87% respectively). Twenty-two subjects reported fear of something; 4 females and 4 males reported they were not fearful. Common fear themes included death/loss, health, failure, and insects. Sixty-four percent endorsing fear included one response related to death, loss of loved ones, or decline in health. Fear of failure and fear unrelated to death were reported by 36% and 50% respectively.
This is the first study to assess self-esteem, interpersonal conflicts, and fear in persons with CF. We confirmed a high proportion would report health fears. However, 27% reporting fear worried about death of others in addition to, or instead of, their own mortality. Fifty percent reported fears common to the general population. Encouraging findings include low substance use and conflict with parents, and high self-esteem and satisfaction with appearance. Limitations include a small sample recruited from a single center.
These findings are encouraging. However, a sizable proportion reported fear about death, health, or health of loved ones; likely the consequence of health burden and concern about early mortality.
Garcia G, Snell C, Sawicki G, et al. Mental Health Screening of Medically-Admitted Patients With Cystic Fibrosis. Psychosomatics, 2018;59(2):158–168.
Quittner AL, Goldbeck L, Abbott J, et al. Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of The International Depression Epidemiological Study across nine countries. Thorax. 2014;69(12):1090-1097.