(293) Longitudinal Mental Health Trends in Pediatric Cystic Fibrosis

Background: People with cystic fibrosis (CF) are more likely to have increased anxiety and depression symptoms compared to the general population, with psychological distress being associated with negative health outcomes. The CCHMC CF Center has been screening people with CF 12 years and older since 2016 for anxiety and depressive symptoms. Little is known about longitudinal mental health trends for youth with CF, especially during the COVID-19 pandemic.

Methods: Chart review was conducted for individuals 12 years and older seen for routine care at our center with at least one GAD-7 or PHQ-9 screening result between Jan 2016 and Dec 2021. Data included demographics, dates and scores of GAD-7 and PHQ-9, mental health encounters 12 months prior to each screening date, and clinical variables of disease severity including percent predicted FEV1 (FEV1pp), BMI, CFRD, antibiotics in the 28 days prior, and exacerbations in the 12 months prior. Descriptive statistics were used to summarize demographic variables, logistic regression and linear mixed modeling was used to identify predictive relationships, and t-tests were used to compare impact of COVID to prior years.

Results: The sample included 150 individuals with at least one screen across the six years. An average of 83 people completed at least one GAD-7 or PHQ-9 in each year. Across the 6 year time period, the percent of individuals with minimal range scores increased, and the percent of people with moderate to severe scores was stable (Figure 1). Approximately 35% of individuals were rescreened at least once in a given year due to a previously elevated symptom score. For those who screened in the moderate-severe range (> 10) on initial screens per year, an average of 32% (GAD-7) and 37% (PHQ-9) had a reduced score (< 10) on their second screen per year.



Individuals who scored > 10 on initial GAD-7 or PHQ-9 screens of any year were statistically more likely to have a CFRD diagnosis (p=0.02,GAD-7; p=0.02, PHQ-9) and higher numbers of psychology/psychiatry visits 12 months prior to the screening date (p< 0.01, GAD-7; p< 0.01, PHQ-9) compared to those who with minimal scores. In addition, PHQ-9 scores > 10 were significantly associated with lower FEV1pp compared to minimal scores.



Adherence to screening protocols consistently increased over time. Of all eligible individuals, 56% completed a GAD-7 and 55% a PHQ-9 in 2016, increasing to 92% and 94% respectively by 2021 despite the impact the COVID-19 pandemic had on CF care visit frequency. GAD-7 scores were not significantly different pre-COVID to COVID years (p=0.06), and PHQ-9 scores were higher in pre-COVID years when compared to COVID years (p=0.02) despite similar number of screens conducted per year.

Conclusions: These longitudinal trends in mental health symptom scores over time are reassuring, with increasing frequency of minimal scores and stable moderate to severe scores. This may be due to increased awareness of mental health symptoms, more interventions through care teams, or improved access to resources. Similarly, while general population data suggests worsening of anxiety and depressive symptoms in the COVID-19 pandemic, we hypothesize we were able to buffer the impact of the pandemic on the mental health in our center through efforts of screening and respond to screens during that time. These results highlight the importance of consistent monitoring and support for the mental health symptoms in people with CF.

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