SCD is a major genetic disease that negatively impacts individuals in Sub-Saharan African countries [1]. According to the WHO [1] the disease upsets hemoglobin. This results in frequent pain and medical problems that in turn negatively affect the patients’ education, employment, and psychosocial development [1].
The WHO further noted the highest prevalence of hemoglobin AS in Africa as occurring “between latitudes 150 North and 200 South, ranging between 10 and 40 % of the population in some areas. Prevalence levels decrease to between 1 and 2 % in North Africa and less than 1 % in southern Africa” [1]. Ghana, Nigeria, Cameroon, Republic of Congo, and Gabon have prevalence between 20 and 30 % while it is as high as 45 % in some parts of Uganda [1–3].
The reason the sickle cell has maintained such high prevalence levels in tropical Africa is because the sickle cell trait partially protects against malaria [1, 4]. However, individuals who are homozygous for gene S do not have defense against malaria and consequently suffer from severe sickle cell disease, with a lot of them dying before attaining the age of procreation [1]. Such HbSS individuals usually die from an infection or severe anemia [5]. Those who survive into adulthood remain susceptible to exacerbations of the disease and its medical and psychosocial complications [6].
With the present lack of cure, many adults with SCD are believed to live in fear of early death or have death anxiety and many other psychological complications [7]. There are effective treatments using painkillers for the sickle cell pain. Other complications of sickle cell disease are treated using antibiotics. Rest, balanced diet, folic acid supplementation and high fluid intake, plus occasionally needed aggressive procedures like transfused blood and operation are used [8]. However, psychological difficulties accompany these medical complications and treatments. According to Anie [7], Becker, Axelrod, Oyesamni, Markov and Kunkei [9] and Levenson et al. [10], psychological complications and “psychiatric issues are common in sickle cell disease” [11].
Psychological symptoms have been reported in western literature to be highly prevalent among adults with sickle cell disease [10–13]. Depression rates, for example, are comparable to those found in other serious chronic medical diseases. These range “from 18 to 44 %” [11, 14–16]. Depression rates among people living with sickle cell disease are higher than rates in the general population despite controlling for illness-related physical symptoms [11, 17]. Twenty-seven and half percent of adults with sickle cell disease were reported in a PiSCES study as having depression and 6.5 % as having anxiety [10]. The PiSCES project study found that depressed and anxious sickle cell disease persons functioned poorly and used opioids and hospital emergency services frequently [11].
In Africa, however, published literature about psychological symptoms in SCD is scarce. It is only in Nigeria in West Africa that prevalence of specific psychological symptoms in SCD have been reported. Prevalence of depression, for example, was reported higher among sickle cell participants in a Nigerian study than among cancer or malaria study participants. Depression, however, was reported to be lower in persons with SCD than it was in persons living with HIV-AIDs [11, 18]. A similar research studied psychosocial impact of sickle cell disorder in a Nigerian setting. From a sample of 408 adolescents and adults attending three hospitals in Lagos, Nigeria, the authors found depression to be commonly experienced among half of the study participants, while feelings of anxiety and self-hate were uncommon [19].
Since psychological symptoms have implications for physical complaints in sickle cell disease, their study emphasizes the importance of studying psychological symptoms among persons with SCD. The implications are that psychological symptoms are known to contribute to vaso-occlusive crisis and other physical complaints. For example, major depression was reported to increase sickle cell chronic disease patients’ burden of physical illness and symptoms, their functional disabilities and medical costs [20]. Some researchers reported that it is better to consider psychological variables as contributing to the onset of sickle cell pain. For example, Pell and colleagues [21] found that higher levels of kinesophobia were associated with greater psychological distress. Their findings suggest that, it could be psychological distress that increased kinesophobia or kinesophobia increased psychological distress since the analysis was correlational. The psychological symptoms that were associated with higher levels of kinesophobia were Phobic Anxiety, Psychoticism, Somatization, Anxiety, Obsessive-Compulsive, Interpersonal Sensitivity, and depression. Some research found that psychological problems that sickle cell disease patients most frequently encountered are increased anxiety, depression, social withdrawal, aggression, poor relationships, and poor school performance [22].
Elsewhere, it was found that stigmatization in SCD for pseudo-addiction to opioid analgesics was also related to anxiety and depression [10, 23]. Depression was found to powerfully predict physical and mental health-related quality of life than was genotype [10]. Depression in SCD individuals is associated with increased emergency room treatments, hospital admissions, chronic pain flares, SCD crisis, and higher levels of related psychological disorders.
Another importance of examining psychological symptoms is that symptoms of fatigue, appetite disturbance, and irritability are present both in sickle cell anemia and in clinical depression. Patients with the most clinically severe pain also show the greatest prevalence of depression [14, 15].
An association between anxiety, poorer health-related quality of life, and more pain in SCD was established [10]. Therefore, Levenson and colleagues [10] concluded that anxiety and depression predicted more daily pain and poorer physical and mental quality of life in adults with SCD. These findings point out the importance of recognizing and treating psychological symptoms, particularly anxiety and depression, in adults with SCD.
Although it is a challenge determining the exact prevalence rate of a psychological disorder in any given population, some countries as mentioned above have attempted it and have some figures that guide action, policy and research. This is not the case in Ghana which has no records of national statistics on the prevalence rates of psychological symptoms among sickle cell disease patients. Against this background, this study aimed at investigating the prevalence and exploring psychological symptoms among SCD participants in Accra, Ghana.
Subsequently, the following research questions were posed:
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1.
Is there high prevalence of psychological symptoms among adults with SCD?
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2.
Is there a significant difference in the mean psychological symptoms score for males and females?
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3.
Is there a significant difference in the mean psychological symptoms score for HbSS and HbSC persons?
The study was conceptualized based on the existing theoretical view that women experience and display more psychological symptoms than males [24] and HBSS persons experience more pain and severe psychological distress than HBSC persons [5, 25–27].
This prevalence study was necessary because the lack of baseline data on psychological symptoms makes providing specific psychological services to sickle cell disease individuals uncertain. The study contributed knowledge of prevalence of psychological symptoms from the Ghanaian experience. It contributed information that is lacking on gender and genotype differences in the experience of psychological symptoms. The study firmed up the fact about the low prevalence of psychological symptoms among adults with SCD who live in non-westernized countries as against the high prevalence among those who live in highly industrialized countries. It hints about possible geographical and socio-cultural factors that differentiate psychological symptoms prevalence rates across the world.