# Precariousness Represents an Independent Risk Factor for Depression in Children With Sickle Cell Disease

## TL;DR

This study found that social precariousness is a major risk factor for depression in children with sickle cell disease in French Guiana.

## Contribution

The study is the first to show that social precariousness independently predicts depression in children with sickle cell disease.

## Key findings

- Depression prevalence was 42.5% among children with sickle cell disease.
- Precariousness was significantly more common in depressed children (76%) than in controls (18%).
- Precariousness was an independent risk factor for depression, even with free healthcare.

## Abstract

Importance: While the prevalence and impact of depression have been widely described in sickle cell disease, its relationship with precariousness has never been studied.

Objective: This study aimed to describe the prevalence of depression and its relationship with clinical and demographic factors including social precariousness in children with sickle cell disease in French Guiana.

Methods: We included children aged 12–18 years with sickle cell disease from the Sickle Cell Reference Center in French Guiana. A simple depression questionnaire “Child depression inventory 2” was proposed and completed by a clinical examination and consultation by a psychologist. Using the known assessment of health inequalities and poverty in health screening centres (EPICES) score, we developed a composite precariousness score that uses five items (each item is scored from 0 to 2). According to the chosen items, precariousness was defined as a score ≥5.

Results: The prevalence of depression was 42.5% [95% CI: 31.5–54]. The median age was 15 years [95% CI: 13–17]. The age distribution peaked at 14 years in patients with depression. There were 76% of precarious patients in the depressed group and 18% in the control group (p  < 0.0001). In multivariate analysis, genotype SC (OR = 7.66, [1.17; 50.13], p=0.0338) and precariousness (OR = 15.68, [4.73; 51.94], p  < 0.0001) were associated with higher rates of depression. Baseline hemoglobin levels (OR = 0.48, [0.27; 0.88], p=0.0173) were also associated with lower rates of depression.

Conclusions and Relevance: Despite free healthcare, precariousness is an independent risk factor for depression.