{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T15:34:45Z","timestamp":1787758485301,"version":"build-2784847793"},"reference-count":38,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Blood &amp; Cancer"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Anxiety and depression are common yet often underrecognized comorbidities in people with sickle cell disease (PwSCD), contributing to poor quality of life and adverse health outcomes. However, few large\u2010scale studies have examined whether cerebrovascular accident (CVA)\u2014a major complication of SCD\u2014is associated with higher rates of anxiety and depression. Understanding this relationship is essential to inform early screening and comprehensive, multidisciplinary care for PwSCD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective cohort study utilized the Epic Cosmos database, which includes over 200 million patients from 1118 US health systems (January 2003\u2013December 2022). Cases were defined as PwSCD aged 0\u2013110 years with a documented history of CVA; controls were PwSCD without CVA. Depression and anxiety were identified using ICD\u201010 diagnostic codes. Rates between groups were compared using chi\u2010square tests with Yates\u2019 correction and Bonferroni adjustment (\n                      <jats:italic>p<\/jats:italic>\n                      \u2264 0.0083).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 130,148 PwSCD, 9,306 (7.1%) had a history of CVA. Anxiety and depression were significantly more prevalent in PwSCD with CVA (36.4% and 39.7%) than those without (18.3% and 22.0%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.0083). Females with CVA had higher rates of both conditions (42.3% and 46.2%) than males (28.5% and 30.9%). The largest proportion of patients with anxiety and depression was in the 50\u201364\u2010year age group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PwSCD with a history of CVA are nearly twice as likely to have anxiety and depression as those without. These findings underscore the need for routine anxiety and depression screening and integration of psychosocial care into comprehensive SCD management to improve long\u2010term outcomes and quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/1545-5017.70455","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T03:41:53Z","timestamp":1785382913000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebrovascular Accidents are Associated With Increased Rates of Anxiety and Depression in People With Sickle Cell Disease: A National Database Study"],"prefix":"10.1002","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6390-4299","authenticated-orcid":false,"given":"Andrew D.","family":"Tran","sequence":"first","affiliation":[{"name":"Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-5258-9113","authenticated-orcid":false,"given":"Haya M.","family":"Alsarrawi","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlon Q.","family":"Gragg","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdelrahman","family":"Masri","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Medhavi","family":"Honhar","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Becton","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasmin","family":"Cotoco","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joana M.","family":"Mack","sequence":"additional","affiliation":[{"name":"Arkansas Children's Hospital  Little Rock Arkansas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2009.12.022"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(10)61029\u2010X"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1510865"},{"issue":"49","key":"e_1_2_8_5_1","first-page":"1155","article-title":"Incidence of Sickle Cell Trait\u2013United States, 2010","volume":"63","author":"Ojodu J.","year":"2014","journal-title":"MMWR Morbidity and Mortality Weekly Report"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199107043250103"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2014.10517"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102014\u201011\u2010607317"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1182\/blood\u20102009\u201005\u2010220921"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1586\/ehm.11.61"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1586\/ehm.13.25"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrdp.2018.10"},{"key":"e_1_2_8_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199505183322001"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijs.12357"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1747\u20104949.2012.00906.x"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1161\/STR.0000000000000113"},{"issue":"4","key":"e_1_2_8_17_1","first-page":"268","article-title":"Challenges to Depression Care Documentation in an EHR","volume":"45","author":"Kobus A. 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