Anxiety and Depression in Cystic Fibrosis Ivette Cruz, M.S., 1 Kristen K. Marciel, Ph.D., 1 Alexandra L. Quittner, Ph.D., 1 and Michael S. Schechter, M.D., M.P.H. 2,3 ABSTRACT Symptoms of anxiety and depression have important consequences for patients with chronic disease, including lower rates of adherence and increased morbidity. This review discusses the prevalence of anxiety and depression in patients with cystic fibrosis (CF) across the life span and highlights current understanding of how these symptoms affect adherence, health outcomes, and health-related quality of life (HRQOL). Anxiety and depression appear to be more common in patients with CF than in the general population. Recent studies also indicate that symptoms of anxiety occur more frequently than depression in this population. Both anxiety and depression have been shown to be associated with poorer disease outcomes, including HRQOL. Depression, specifically, leads to lower adherence to recommended therapies. Given the prevalence and impact of anxiety and depression in CF, it seems appropriate to recommend annual screening using a validated approach, with referral for either pharmacotherapy or cognitive behavioral therapy of those with apparent symptoms. A large-scale epidemiological study of anxiety and depression in CF is under way and should provide better prevalence estimates and more information on the effects of these psychological symptoms. KEYWORDS: Cystic fibrosis, anxiety, depression, psychological interventions, adherence In the general population, the presence of a chronic illness is a significant risk factor for the develop- ment of mental health disorders such as anxiety and depression. One community–based study reported that individuals with chronic medical conditions have a 41% increased risk of having a psychiatric disorder. 1 Reports of the rate of anxiety in medical populations range from 2 to 45% compared with 2 to 9% in healthy populations, and rates of depression range from 17 to 50% compared with 5 to 17.5% in healthy populations. 2–4 Patients with anxiety and depression present significant treatment challenges to their health care providers because they show worse adherence to prescribed treatments, higher rates of missed or canceled appointments, worse health- related quality of life (HRQOL), increased health care utilization, and higher health care costs. 5–9 These pa- tients were also more likely to engage in risky behaviors, such as smoking, drinking, and drug use. 5,10 Cystic fibrosis (CF) is the most common life- shortening, genetic disease of Caucasian populations. 11 Although life expectancy has increased to 36.9 years, 11 management of CF requires a daily, time-consuming treatment regimen, which can take between 2 and 4 hours per day. 12 Although recent research has provided a better understanding of the pathophysiology of the disease and led to the development of new treatments, 1 Departments of Psychology and Pediatrics, University of Miami, Coral Gables and Miami, Florida; 2 Department of Pediatrics, Division of Pulmonary, Allergy/Immunology, Cystic Fibrosis and Sleep, Emory University School of Medicine, Atlanta, Georgia; 3 Children’s Healthcare of Atlanta, Atlanta, Georgia. Address for correspondence and reprint requests: Ivette Cruz, M.S., Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd., Coral Gables, FL 33146 (e-mail: i.cruz1@umiami.edu). Cystic Fibrosis; Guest Editors, John R. McArdle, M.D. and Laurie A. Whittaker, M.D. Semin Respir Crit Care Med 2009;30:569–578. Copyright # 2009 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel: +1(212) 584-4662. DOI 10.1055/s-0029-1238915. ISSN 1069-3424. 569