(312) Barriers to sustaining daily care in adults with CF with mild depression and anxiety

Background: CFF/ECFS guidelines recommend annual depression/anxiety screening for adults with CF (awCF), but those with mild symptoms are understudied, despite risk for progression. Previous baseline analyses of a 4-site randomized waitlist-controlled trial (RCT) of a CF-specific cognitive-behavioral therapy (CBT) intervention, CF-CBT, in awCF with mild symptoms of depression and/or anxiety revealed elevated Perceived Stress Scale (PSS) scores and reduced health-related quality of life (HRQoL) on the Cystic Fibrosis Questionnaire-Revised (CFQ-R) vs. previous national samples.[1] We aimed to use the Daily Care Check-In (DCC) to examine barriers to sustaining daily care in this cohort.

Methods: AwCF with mild-range depression and/or anxiety screening scores (PHQ-9/GAD-7 of 5-9, with neither score >9) participating in the CF-CBT RCT (N=60) completed baseline measures prior to randomization. Univariate analysis was used to examine the associations of DCC Frequency and Interference scales with sociodemographics (age, sex, income, education), advanced disease status (ppFEV₁< 40, home oxygen use, or referred for/post-transplant), PSS and CFQ-R. Linear regression models were then used to select variables associated with each outcome independently, using a forward stepwise approach.

Results: Mean age was 33 years (range 19-63); 65% female; 3.3% Hispanic/Latinx; 95% white; 42% working full-time, 4% part-time; 12% students; 27% disabled. PpFEV₁ ranged from 16-124 (M=69), 12 had advanced disease, and 5 were post-transplant. For DCC Frequency (Table 1), the mean number of reported barriers to daily care in the past 6 months (yes/no) was 8.6 out of a possible 18 (range 0-14). Mean DCC Interference, summing how often (1=never to 5= always) these barriers get in the way of doing treatments, was 27.6 out of 90 (range 0-47). Following univariate analysis, sex, PSS, advanced disease, and all CFQ-R subscales were considered for stepwise modeling. For DCC Frequency, being female (r= 2.038, p= .010) and lower HRQoL on the CFQ-R subscales of Treatment Burden (r= -.069, p< .001) and Body Image (r= -.050, p=.002) remained in the final model. For DCC Interference, being female (r= 6.66, p=.005) and lower HRQoL on CFQ-R Treatment Burden (r= -.134, p=.025), Body Image (r= -.128, p= .009) and Physical Functioning (r= -.090, p= .045) remained in the final model (p< .05). High perceived stress (PSS) was significantly associated with both DCC Frequency (r= .333, p=.009) and DCC Interference (r= .270, p=.036) in univariate analysis, but did not remain in the final model because it was also strongly related to multiple CFQ-R subscales.

Conclusions: This cohort of awCF endorsing mild symptoms of depression/anxiety reported multiple barriers to sustaining daily care; women and those reporting worse treatment burden, body image, and physical functioning may be at higher risk. These findings support the potential value of specialized interventions, such as CF-CBT, that include a specific focus on strategies to address the interplay of depression, anxiety and sustaining daily care.

Acknowledgements: This work was supported by the CF Foundation [FRIEDM18A0-I].

References: [1] Friedman D, Smith B, Sher Y, Bruce A, Chaudhary N, Hardcastle M, Pollinger S, Polineni D, Mohabir P, Shea N, Roach C, Miller C, Richards C, Dvorak M, Quittner A, Georgiopoulos A. Perceived stress and quality of life in adults with CF with mild depression and anxiety. Journal of Cystic Fibrosis. 2021 Nov 1;20:S145-6.