{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T18:00:35Z","timestamp":1790272835338,"version":"4.1.0"},"reference-count":38,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Pain related to sickle cell disease (SCD) is complex and associated with social determinants of health. Emotional and stress-related effects of SCD impact daily quality of life and the frequency and severity of pain.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To explore the association of educational attainment, employment status, and mental health with pain episode frequency and severity among individuals with SCD.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This is a cross-sectional analysis of patient registry data collected at baseline (2017-2018) from patients treated at 8 sites of the US Sickle Cell Disease Implementation Consortium. Data analysis was performed from September 2020 to March 2022.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Electronic medical record abstraction and a participant survey provided demographic data, mental health diagnosis, and Adult Sickle Cell Quality of Life Measurement Information System pain scores. Multivariable regression was used to examine the associations of education, employment, and mental health with the main outcomes (pain frequency and pain severity).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The study enrolled a total of 2264 participants aged 15 to 45 years (mean [SD] age,\u200927.9 [7.9] years; 1272 female participants [56.2%]) with SCD. Nearly one-half of the participant sample reported taking daily pain medication (1057 participants [47.0%]) and\/or hydroxyurea use (1091 participants [49.2%]), 627 participants (28.0%) received regular blood transfusion, 457 (20.0%) had a depression diagnosis confirmed by medical record abstraction, 1789 (79.8%) reported severe pain (rated most recent pain crises as \u22657 out of 10), and 1078 (47.8%) reported more than 4 pain episodes in the prior 12 months. The mean (SD) pain frequency and severity\n t<\/jats:italic>\n scores for the sample were 48.6 (11.4) and 50.3 (10.1), respectively. Educational attainment and income were not associated with increased pain frequency or severity. Unemployment (\u03b2,\u20092.13; 95% CI, 0.99 to 3.23;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and female sex (\u03b2,\u20091.78; 95% CI, 0.80 to 2.76;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) were associated with increased pain frequency. Age younger than 18 years was inversely associated with pain frequency (\u03b2,\u2009\u22125.72; 95% CI, \u22127.72 to \u22123.72;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and pain severity (\u03b2,\u20095.10; 95% CI, \u22126.70 to \u22123.51;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001). Depression was associated with increased pain frequency (\u03b2,\u20092.18; 95% CI, 1.04 to 3.31;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) but not pain severity. Hydroxyurea use was associated with increased pain severity (\u03b2,\u20091.36; 95% CI, 0.47 to 2.24;\n P<\/jats:italic>\n \u2009=\u2009.003), and daily use of pain medication was associated with both increased pain frequency (\u03b2,\u20096.29; 95% CI, 5.28 to 7.31;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and pain severity (\u03b2,\u20092.87; 95% CI, 1.95 to 3.80;\n P<\/jats:italic>\n \u2009&amp;lt; .001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n These findings suggest that employment status, sex, age, and depression are associated with pain frequency among patients with SCD. Depression screening for these patients is warranted, especially among those experiencing higher pain frequency and severity. Comprehensive treatment and pain reduction must consider the full experiences of patients with SCD, including impacts on mental health.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2023.14070","type":"journal-article","created":{"date-parts":[[2023,5,18]],"date-time":"2023-05-18T11:02:55Z","timestamp":1684407775000},"page":"e2314070","source":"Crossref","is-referenced-by-count":41,"title":["Examining Mental Health, Education, Employment, and Pain in Sickle Cell Disease"],"prefix":"10.1001","volume":"6","author":[{"given":"Kelly M.","family":"Harris","sequence":"first","affiliation":[{"name":"Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri"},{"name":"Department of Surgery, Division of Public Health Sciences, Washington University in St Louis School of Medicine, St Louis, 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Chicago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Glassberg","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cathy L.","family":"Melvin","sequence":"additional","affiliation":[{"name":"College of Medicine, Department of Public Health Sciences, Medical University of South Carolina, Charleston"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Gibson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Augusta University, Medical College of Georgia, Augusta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Allison A.","family":"King","sequence":"additional","affiliation":[{"name":"Program in Occupational Therapy, Washington University in St Louis School of Medicine, St Louis, Missouri"},{"name":"Department of Surgery, Division of Public Health Sciences, Washington University in St Louis School of Medicine, St Louis, Missouri"},{"name":"Department of Pediatrics, Division of Pediatric Hematology\/Oncology, St Louis Children\u2019s Hospital, Washington University in St Louis, School of Medicine, St Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Sickle Cell Disease Implementation Consortium","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2023,5,18]]},"reference":[{"issue":"4","key":"zoi230431r1","doi-asserted-by":"publisher","first-page":"S512","DOI":"10.1016\/j.amepre.2009.12.022","article-title":"Population estimates of sickle cell disease in the U.S.","volume":"38","author":"Hassell","year":"2010","journal-title":"Am J Prev 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