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BACKGROUND: Patients with cystic fibrosis (CF) and their caregivers experience higher levels of anxiety and depressive symptoms than those without chronic illness.3 Anxiety and depressive symptoms are correlated with poorer compliance with medical regimens 1,4 and poorer health outcomes. 5, 6 Findings suggest that caregivers endorse a higher level of anxious and depressive symptomology than patients with CF. 3 In June 2016 a Quality Improvement project was undertaken to screen and treat anxiety and depressive symptoms in patients with cystic fibrosis and their caregivers, based on the Cystic Fibrosis Foundation and European Cystic Fibrosis Society published consensus on mental health. 2

METHODS: Western Michigan University Homer H. Stryker, MD School of Medicine received a Cystic Fibrosis Foundation grant to facilitate use of the PHQ-9 and GAD-7 with caregivers and patients over the age of 12. Specifically, CF patients age 12 years through adulthood, and caregivers of children with CF from birth to 18 years of were screened with the GAD-7 and the PHQ-9.

RESULTS: In the 15 months of screening, there were 90 total GAD-7 and PHQ-9 screens. Twenty-nine (29) individuals were screened with the GAD-7 more than one time with a range of 1- 5 separate screens. Similarly, 28 individuals were screened with the PHQ-9 more than one time with a range of 1-5 separate screens. The 15-month data shows that although more caregivers than patients were screened, the ratio of caregivers and patients without symptoms to those with symptoms were similar. That is, 55% of caregivers and 60% of patients endorsed no anxiety symptoms, 45% of caregivers and 40% of patients scored symptomatically. In terms of depressive symptoms, 54% of caregivers and 76% of patients scored asymptomatically and 46% of caregivers and 24% of patients scored symptomatically. Screenings of caregivers and their own child on the same date (N=11), showed the majority of paired scores were asymptomatic anxiety scores (N=5). In three caregiver-patient pairs, caregivers were asymptomatic and patients were symptomatic and in three caregiver-patient pairs, patients were asymptomatic and caregivers were symptomatic for anxiety. Depressive symptom screenings showed seven pairs were asymptomatic (N=11), two pairs showed caregivers were asymptomatic and patients were symptomatic, and two pairs showed patients without symptoms and caregivers with symptoms.

CONCLUSION: Fifteen months of screening shows that symptoms of anxiety and depression occurred in roughly half of patients with CF and caregivers. Patients reported lower levels of depressive symptoms than caregivers. Additional screenings of caregivers and their children are needed to more fully understand the nature and course of anxiety and depressive symptoms among caregivers and patients with CF.


  1. Barker DH, Quittner AL. Parental Depression and Pancreatic Enzymes Adherence in Children with Cystic Fibrosis. Pediatrics. 2016; 137(2)e20152296.
  2. Quittner AL, Abbott J, Georgiopoulos AM, et al. International Committee on Mental Health. International Committee on Mental Health in Cystic Fibrosis: Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus statements for screening and treating depression and anxiety. Thorax. 2016 Jan;71(1):26-34. doi: 10.1136/thoraxjnl-2015-207488. Epub 2015 Oct 9.
  3. Quittner AL, Goldbeck L, Abbott J, et al. Prevalence of Depression and anxiety in patients with cystic fibrosis and parent caregivers: results of the International Depression Epidemiological Study across nine countries. Thorax. 2014; 69:1090-1097.
  4. Smith BA, Modi, Quittner AL, Wood BL. Depressive symptoms in children with cystic fibrosis and parents and its effects on adherence to airway clearance. Pediatric Pulmonology. 2010; 45:756-63.
  5. Snell C, Fernandes S, Bujoreanu IS, Garcia G. Depression, illness severity, and healthcare utilization in cystic fibrosis. Pediatric Pulmonology. 2014; 49:1177-81.

Schechter MS, Ostrenga J, Fink A, Barker D, Sawicki GS, Quittner AL. Five year survival is decreased in CF patients screening positive for depression. Pediatric Pulmonology. 2017; 52:404-405.

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