Trait anxiety in Sickle Cell Disease : investigating and exploring links to the management of pain

Abstract

The current sequential explanatory mixed-methods study investigated the relation of trait anxiety and health outcome variables (pain intensity, depression, quality of life, hospitalisation frequency) in Sickle Cell Disease (SCD). SCD is a hereditary blood disease that causes frequent pain in people with the disease. Pain management is a goal of disease management in SCD. Trait anxiety was used as a hyper-vigilance construct to investigate the relationship between hyper-vigilance and health outcomes in SCD and across an illness comparison group (Blood Cancer, BC) and an illness exposure control group (Carers). Participants (N = 51) completed online self-report measures of anxiety, depression, pain intensity and quality of life. Hierarchical regression results showed that the variance in trait anxiety was significantly predicted by: depression scores (48.1%, p = .001) and quality of life scores (27.1%, p = .001) in the complete sample (SCD, BC, Carers); and by depression scores (67.2%, p = .001) and quality of life scores (17.7%, p = .021) in the complete SCD sample (n = 28). Multivariate results with equal group sizes (n = 24) revealed the SCD group experienced significantly greater sensory pain (p = 0.018) and lower general health (p = 0.019) relative to Carers. The SCD group also experienced significantly lower depression (p = 0.044) relative to the BC group despite having similar levels of trait anxiety as the BC group. Thematic analysis of qualitative semi-structured interview data revealed six themes: pain appraisal, purpose and change in identity, coping strategies, anger and frustration, social construction of illness and personal control. Data integration showed hyper-vigilance behaviour was more prominent in SCD, relative to BC and more likely to be used as an adaptive coping strategy in pain monitoring and prevention, or in pain adjustment. Counselling psychologists and healthcare practitioners may need to consider that reducing hyper-vigilant behaviour in SCD may increase pain experience and affect pain management negatively.