Depression and Anxiety in Children with Congenital Adrenal Hyperplasia

Abstract

: Background : Congenital adrenal hyperplasia (CAH) is a genetic chronic disease in which both adrenal insufficiency and adrenal androgen excess coexist associated with life-long therapy, supraphysiological dose of glucocorticoid and demanding psychological aspects. Patients and methods : This cross sectional study included 33 children with CAH who were following up at Endocrinology outpatient clinic, Specialized Pediatric Hospitals, Cairo University Hospitals, Egypt, and apparently age and gender- matched healthy 33 normal children as controls. Depression severity was assessed using the Children’s Depression Inventory (CDI) and the Spence Children’s anxiety Scale was used to assess six areas of anxiety in both studied groups. Results : The CAH comprised 16 (48.5%) girls and 17 (51.5%) boys with mean ±SD age of 9.63years ± 2.5 and 9years ± 2.82 respectively. According to Spence score none of the cases and controls had abnormal anxiety level of more than 60 which is considered the highest level of normal. The mean ±SD of total anxiety score in the cases (36.27±8.55) was higher mean ±SD of total anxiety score in the control group (30.15±3.52) (p=0.005). The mean ±SD of the CDI score of the cases was 13.79±5.16, while that of the control group was 11.115±2.7, which was not statistically significant (p=0.080). But mild depression was found in 12 (36.4 %) of CAH cases and moderate depression in 3 (9.1%). The total score of CDI and Spence anxiety scale correlated positively with current age of the cases (p=0.006) and (p= 0.028) respectively, androstenedione level (p= 0.001) and (p= 0.0001) respectively, 17 hydroxyprogesterone level (p=0.001) and (p= 0.0001) respectively, age at genitoplasty surgery (p= 0.006) and (p= 0.006) respectively, dose of hydrocortisone (p=0.0001) and (p= 0.002 respectively), and negatively with age at diagnosis (p=0.036) and (p= 0.008 respectively. Conclusion : Not all cases of CAH had depression and none of them had abnormal anxiety level. Early genitoplasty surgery was a protecting factor for CAH cases against development of depression and anxiety, while disease chronicity with high glucocorticoid dose therapy was a precipitating factor for depression in those children.