Haemophilia. 2020;00:1–7. wileyonlinelibrary.com/journal/hae | 1 © 2020 John Wiley & Sons Ltd 1 | INTRODUCTION Haemophilia is a rare chronic disease that affects a small num- ber of patients, but the costs of treatment are high in European countries, as shown by the CHESS study. 1 The vast majority of the cost burden (up to 99%) was the cost of the factor replacement therapy. 1 Nonadherence to medication regimens is a real public health problem. 2 Therefore, it is of great importance to exam- ine and understand the factors contributing to adherence rate to prophylaxis in haemophilia. Prophylaxis diminishes frequency of bleeding; therefore, it may slow progression of joint disease and improve quality of life. 3 Patients with haemophilia (PWH) Received: 23 January 2020 | Revised: 12 March 2020 | Accepted: 6 April 2020 DOI: 10.1111/hae.14011 ORIGINAL ARTICLE Depressive symptoms and adherence to prophylaxis in patients with haemophilia from Croatia and Slovenia Martina Bago 1 | Ana Butkovic 2 | Irena Preloznik Zupan 3,4 | Barbara Faganel Kotnik 3,4 | Ivana Prga 1 | Vesna Bacic Vrca 5,6 | Silva Zupancic Salek 7,8 1 Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia 2 Faculty of Humanities and Social Sciences, University of Zagreb, Zagreb, Croatia 3 University Medical Centre Ljubljana, Ljubljana, Slovenia 4 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia 5 Clinical Hospital Dubrava, Zagreb, Croatia 6 Faculty of Pharmacy and Biochemistry, University of Zagreb, Zagreb, Croatia 7 University Hospital Centre Zagreb, Zagreb, Croatia 8 Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia Correspondence Martina Bago, Andrija Stampar Teaching Institute of Public Health, Zagreb, Croatia. Email: martina.bago.hr@gmail.com Introduction: Adherence to a prophylactic therapy is obligatory to prevent bleeding in patients with haemophilia. It has already been recognized that depression is associ- ated with treatment adherence. Aim: The aim of this study was to examine the prevalence of depressive symptoms in adults with haemophilia using an instrument designed or validated for diagnosing or screening for depression and to investigate the association of symptoms of depres- sion with nonadherence to prophylactic therapy in patients from two East European countries. Methods: Adult patients with severe or moderate haemophilia receiving prophylaxis were eligible for the study. Depressive symptoms were assessed with BDI-II, adher- ence with VERITAS-Pro, demographic and socioeconomic data were collected using a questionnaire, and clinical data were obtained from medical records. Results: Final sample included 81 participants (median age was 45 years, range 18-73 years). There were 9 (11%) participants with scores on BDI-II above 14 points, the cut-off score for depressive symptomatology. In general, participants were ad- herent. However, there were 14 (17%) participants who had scores above 57 points, the cut-off score for nonadherence. There was an association between having de- pressive symptoms and being nonadherent, and depressive symptoms explained ad- ditional variance in adherence after controlling for sociodemographic, psychosocial and clinical characteristics. Conclusion: Since there is an association between depressive symptoms and non- adherence, it would be beneficial for both patients and the public health system for screening for depressive symptoms to be included as a part of the treatment protocol. KEYWORDS adherence, haemophilia, symptoms of depression