Integrated Psychiatry in a Young Adult Sickle Cell Clinic: Referral and Engagement

Background/Significance:

Young adults (YA) with sickle cell disease (SCD) transition to adult care during emerging adulthood (18-25). Both young adulthood and SCD are risk factors for depression (Kessler, 1998; Levenson, 2008) and, in SCD, depression is associated with worse quality of life and greater acute-care utilization (Adam, 2017). Psychiatric care is a component of comprehensive SCD care (Kanter, 2020) but psychiatry integrated into SCD clinics is rare. This study describes referral to and engagement with integrated psychiatric services in a YA SCD clinic.

Methods:

This IRB approved retrospective study included YA who established care in the YA clinic of the XXX SCD Center before February, 2022 and were followed for at least one year. Demographics, SCD genotype, and psychiatric referral, visits and diagnoses were collected. Statistical tests will examine the association of engagement with timing of referrals and scheduling with psychiatric services.

Results:

137 patients established care in the YA clinic and were followed for at least 1 year. Within the first year of establishing care, 59 (43%) patients were referred to psychiatry, and 38 (63%) of those referrals occurred at the initial hematology visit. Among referred patients, 60% were scheduled within 6 weeks. By the end of the first year, 56% engaged with psychiatry. Mood disorders were diagnosed in 70% of patients who engaged with psychiatry.

Discussion:

Nearly half of YA establishing care at our comprehensive SCD center are referred to the integrated psychiatry service, and over half of those referred engaged with psychiatry care. Referral and engagement are greater than observed in a prior study involving screening and self-referral by a mental health clinician (Robbins, 2020). Psychiatry referral for YA patients occurred early in integration into adult care. Clinical diagnosis of mood disorders was common in patients that engaged, similar to observations from screening tool studies (Levenson, 2008). Referral by primary hematologist, as well as the time to scheduling psychiatric appointment may promote psychiatry engagement in this care model.

Conclusion/Implications:
Mood disorders in YA with SCD are common and integrated psychiatry in a YA clinic focused on the medical, psychiatric and developmental needs for patients with SCD is part of optimal care for integration into adult care systems.

References:

Kessler RC, Walters EE. Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey. Depress Anxiety. 1998;7(1):3-14.

Adam SS, Flahiff CM, Kamble S, Telen MJ, Reed SD, De Castro LM. Depression, quality of life, and medical resource utilization in SCD. Blood Adv. 2017 Oct 12;1(23):1983-1992.

Kanter J, Smith WR, Desai PC, Treadwell M, Andemariam B, Little J, Nugent D, Claster S, Manwani DG, Baker J, Strouse JJ, Osunkwo I, Stewart RW, King A, Shook LM, Roberts JD, Lanzkron S. Building access to care in adult SCD: defining models of care, essential components, and economic aspects. Blood Adv. 2020 Aug 25;4(16):3804-3813.

Robbins MA, Carroll CP, North CS. Psychological symptom screening in an adult SCD clinic and predictors of treatment follow up. Psychol Health Med. 2020 Dec;25(10):1192-1200.