ORIGINAL ARTICLE

Coping and health service utilisation in a UK study of paediatric sickle cell pain

K A Anie¹, A Steptoe², S Ball³, M Dick⁴, B M Smalling⁵

¹ Brent Sickle Cell and Thalassaemia Centre, Department of Haematology, Central Middlesex Hospital, London, UK
² Department of Epidemiology and Public Health, University College London, UK
³ Department of Haematology, St George's Hospital Medical School, London, UK
⁴ Department of Haematological Medicine, King's College Hospital, London, UK
⁵ City and Hackney Sickle Cell and Thalassaemia Centre, London, UK

Correspondence to:
Correspondence to:
Dr K Anie, Brent Sickle Cell and Thalassaemia Centre, Department of Haematology, Central Middlesex Hospital, London NW10 7NS;
kofi{at}sickle-psychology.com

Aims: To assess sickle cell pain and coping in children and to examine the relation between these factors and the utilisation of health services.

Methods: Cross sectional study involving 67 children with sickle cell disease attending three London hospitals. Interviews and questionnaires involved measures of pain, health service utilisation, and coping responses (measured with the Coping Strategies Questionnaire (CSQ), revised for children with sickle cell disease). Medical data on complications, haemoglobin (Hb) levels, and foetal haemoglobin (HbF) percentage were also collected.

Results: Pain accounted for about 24% of hospital service use, independent of age, sex, number of with sickle cell disease complications, and Hb levels. However, 42% of patients had not utilised hospital services in the past 12 months. Three higher order factors emerged from analysis of the CSQ (active coping, affective coping, passive adherence coping). Pain severity was predicted by passive adherence coping, while utilisation of hospital services was predicted by active coping.

Conclusions: Sickle cell disease in children involves severe recurrent pain leading to hospitalisation in some cases. Psychological coping patterns are relevant to both pain experience, and the use of acute hospital services. It is likely that children would benefit from community based interventions that incorporate both medical and psychological assessments.

Keywords: sickle cell pain; psychological coping; health service utilisation

Abbreviations: CSQ, Coping Strategies Questionnaire; Hb, haemoglobin; HbF, fetal haemoglobin; HbSThal, sickle thalassaemia disease; HbSßThal, sickle ß thalassaemia disease; HbSC, sickle haemoglobin C disease; HbSS, sickle cell anaemia; SCD, sickle cell disease

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