Screening for the 'Silent' Burden of Menstrual and Mental Health Among Women with Sickle Cell Disease: A Prospective Study.

Abstract

This study screened for major depression and generalized anxiety disorder (GAD) across the menstrual cycle among women with sickle cell disease (SCD) and examined associations with heavy menstrual bleeding (HMB), dysmenorrhea, and sex hormones. A total of 125 Jamaican women aged 18 and over with SCD, regular menses, and no recent hormonal contraceptive use completed follicular- and luteal-phase visits including serum estradiol and progesterone measurements and validated mental and menstrual health and quality-of-life questionnaires. Higher Menstrual Symptom Questionnaire and Menstrual Bleeding Questionnaire scores reflect more severe menstrual pain and menstrual heaviness, respectively, including quality-of-life impact. Menstrual scores were standardized as z-scores and odds ratios represent the change in odds per one-standard deviation change from the sample mean. Major depression and GAD were screened using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Screen-positive rates for major depression and GAD were 44.8% and 39.2% with no differences between phases; and 32% reported passive self-harm ideations. Marginal mean scores were HMB 11.6 ± 4.9 (scale: 0-24) and dysmenorrhea 62.9 ± 13.5 (scale: 24-120). Worse dysmenorrhea was associated with higher odds of major depression risk (odds ratio, OR = 2.6), whereas better quality-of-life in pain (OR = 0.9) and sleep (OR = 0.8) were associated with lower odds. Severe genotypes (OR = 0.1) and better quality-of-life in stiffness (OR = 0.9) and sleep (OR = 0.9) were associated with lower odds of GAD risk. Estradiol, progesterone, and HMB showed no significant adjusted effects. The high prevalence of GAD and major depression risk, and the association between depression and dysmenorrhea suggest that routine screening is needed in this vulnerable group.