{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:53:22Z","timestamp":1786978402510,"version":"build-2736575974"},"reference-count":31,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2025,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Although modulator therapies have proven effective in cystic fibrosis (CF) access is limited due to reimbursement issues in Turkey. We aimed to examine anxiety and depression levels of people with CF (pwCF) and their caregivers according to their access to modulator treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Participants genetically eligible for elexacaftor\/tezacaftor\/ivacaftor (ETI) were divided into Group 1 (access via court decision, not yet on treatment) and Group 2 (unable to access due to reimbursement issues). Genetically ineligible participants formed Group 3. All pwCF and parents of those under 18 were screened for depression by the Patient Health Questionnaire\u20109 (PHQ\u20109) and for anxiety by the Generalized Anxiety Disorder\u20107 (GAD\u20107). Surveys for Group 1 patients were conducted just before starting ETI. Binary logistic regression analysis was performed to evaluate the effects of independent variables on anxiety and depression in pwCF and their primary caregivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 389 pwCF and 285 caregivers were included. Group 3 (ineligible) had the highest depression rate (72.9%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935), while Group 1 (pre\u2010ETI) had the lowest (50.0%,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200935). Median PHQ\u20109 scores were significantly lower in Group 1 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.006). Anxiety rates were higher in Groups 2 and 3 compared to Group 1 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.011 and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.003, respectively). Access to ETI reduced the odds of anxiety by 67.7% (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.029). Caregiver GAD\u20107 scores showed a weak negative correlation with pwCF age (r\u2009=\u2009\u22120.117).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Limited access to modulator therapies is associated with higher depression and anxiety symptoms among pwCF. Addressing these barriers is critical to improving their well\u2010being.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.71037","type":"journal-article","created":{"date-parts":[[2025,3,12]],"date-time":"2025-03-12T03:44:21Z","timestamp":1741751061000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Elexacaftor\/Tezacaftor\/Ivacaftor Treatment Accessibility and Mental Health: Reducing Anxiety in People With Cystic Fibrosis"],"prefix":"10.1002","volume":"60","author":[{"given":"Burcu","family":"Uzunoglu","sequence":"first","affiliation":[{"name":"Selim C\u00f6remen Cystic Fibrosis Center, Pendik Education and Training Hospital Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2146-3966","authenticated-orcid":false,"given":"Merve","family":"Selcuk Balci","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4594-2822","authenticated-orcid":false,"given":"Mine","family":"Kalyoncu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyda","family":"Karabulut","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neval","family":"Metin Cakar","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1964-4263","authenticated-orcid":false,"given":"Ceren Ayca","family":"Yildiz","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamze","family":"Tastan","sequence":"additional","affiliation":[{"name":"Selim C\u00f6remen Cystic Fibrosis Center, Pendik Education and Training Hospital Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damla","family":"Kocaman","sequence":"additional","affiliation":[{"name":"Nutrition and Dietetics, Pendik Education and Training Hospital Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0228-9832","authenticated-orcid":false,"given":"Almala Pinar","family":"Ergenekon","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasemin","family":"G\u00f6kdemir","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ela","family":"Erdem Eralp","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fazilet","family":"Karakoc","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"B\u00fclent","family":"Karadag","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonology, School of Medicine Marmara University Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-023-36244-2"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1183\/23120541.00082-2019"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2021.12.001"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ppul.25285"},{"key":"e_1_2_9_6_1","unstructured":"European Cystic Fibrosis Society Patient Registry. 2021 Annual Report From the European Cystic Fibrosis Society Patient Registry (ECFSPR). 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