How to Screen & Treat Depression in Patients with Cystic Fibrosis
The burden of poor mental health among CF patients is significant and impacts all aspects of disease management. Test yourself on international best practices for screening and treatment.
Given these high rates of emotional distress among patients with CF, as well as parent caregeivers, the International Committee on Mental Health in CF (ICMH) developed a concensus statement for screening and treating depression and anxiety in people with CF across age groups. The sequence of slides above offers a brief test of what you may--or may not--know about caring for the emotional health needs of all persons with CF.
1. At what interval does the ICMH recommend screening for depression and anxiety in children with CF ages 7-11?
Answer: C. When caregivers report symptoms of anxiety/depression. The ICMH does not recommend annual screening for depression and anxiety in children with CF ages 7-11. It does recommend screening when their caregivers report their own increased symptoms of anxiety and depression.
2. At what interval does the ICMH recommend screening for depression and anxiety in teens (≥12 years) and adults with CF?
Answer: B. Annually. The ICMH recommends annual screening for depression & anxiety in all teens & adults with CF starting at age 12. Recommended screening tools: Patient Health Questionnaire-9 (PHQ-9) (measures severity of depression. General Anxiety Disorder-7 (GAD-7), which measures severity of anxiety.
4. In children aged 7-11 with CF and clinically significant depression or anxiety, which of the following is recommended as first-line therapy?
Answer: B. Cognitive behavioral therapy (CBT). There is limited evidence for psychopharmacologic treatment of depression and anxiety in children. ICMH recommends evidence-based psychological interventions in children ages 7-11 with CF and clinically significant depression or anxiety.
5. For individuals aged ≥12 years with CF and mild depression or anxiety, recommended first-line therapy is which of the above?
Answer: B. Education. ICMH recommends that individuals aged ≥12 years with CF and mild depression or anxiety should receive psychoeducation, preventive or supportive psychological interventions, and rescreening at their next clinic visit.
6. For individuals aged ≥12 years with CF and moderate depression or anxiety, recommended first-line therapy is which of the above?
Answer: E. Both B and C. ICMH recommends evidence-based psychological therapy as first-line intervention for patients with CF and moderage depression or anxiety aged ≥12 years. Antidepressants may be considered if behavioral therapy is not available, declined, or not fully effective.
7. For severe depression in patients aged ≥12 years with CF, which of the above is recommended as first-line therapy?
Answer: E. Both B and C. The ICMH recommends a combined approach using antidepressants and evidence-based psychological interventions as first-line treatment for severe depression in patients aged ≥12 years with CF.
SSRIs are recommended as first-line pharmacotherapy.
8. For individuals aged ≥12 years with CF and severe anxiety, which of the above is recommended as first-line therapy?
Answser: A. Exposure-based cognitive behavioral therapy. ICMH recommends exposure-based CBT as first-line therapy in individuals aged ≥12 years with CF and severe anxiety. In general, CBT includes education and cognitive restructuring. Anxiety-specific CBT includes relaxation training and gradual exposure to factors that trigger anxiety.
Rates of depression and anxiety among people with cystic fibrosis (CF) are known to be high. Prevalence of depression among children and adolescents ranges from ~8% to as high as 29% and among adults from 13% to 33%; prevalence of anxiety among adult CF patients has been found to range from 30% to 33%. Depression carries a risk for suicide and recent data from the Cystic Fibrosis Foundation Registry categorized 1.6% of recorded deaths as from suicide.
