Health-Related Quality of Life and Psychosocial Determinants among Adults with Sickle Cell Anaemia in Jazan, Saudi Arabia: A Cross-Sectional Study
TL;DR
Adults with SCA in Jazan experience substantial multi-domain HRQoL impairment, and most screened positive for depressive symptoms at a sensitive threshold, and Integrating routine depression screening with confirmatory assessment, and stigma-reduction programmes, into sickle cell care pathways is warranted.
Abstract
Background: SCA is a major inherited haemoglobinopathy in southwestern Saudi Arabia, where depression, stigma, and social support remain under-studied HRQoL determinants.Objectives: To evaluate HRQoL across the 8 SF-36 domains, determine the prevalence of possible depression using the PHQ-2, and examine associations between HRQoL and sociodemographic and psychosocial factors, including perceived stigma and social support, among adults with SCA in Jazan, Saudi Arabia.Design: Cross-sectional, descriptive-correlational study.Settings: Haematology outpatient clinic of Prince Mohd bin Nasser Hospital, Jazan, Saudi Arabia, August–October 2025.Patients (Materials) and Methods: Adults with SCA confirmed by haemoglobin electrophoresis or HPLC, attending the outpatient clinic, were recruited by convenience sampling and completed a structured, self-administered bilingual questionnaire covering sociodemographic characteristics, the SF-36, and the PHQ-2; data were analysed in SAS 9.4 using descriptive statistics, Pearson correlations, t-tests, and ANOVA.Main Outcome Measures: HRQoL across the 8 SF-36 domains and composite scores; prevalence of possible depression (PHQ-2 ≥3); associations of HRQoL with sociodemographic characteristics, stigma, and social support.Sample Size: 99 adults with confirmed SCA (89% of those approached), consistent with the planned target of ~100 based on 10–15 participants per predictor.Results: Participants were predominantly young (80.8% aged 18–35 years). Role Physical and Role Emotional were the most impaired SF-36 domains, while Bodily Pain and Social Functioning were comparatively preserved; Physical and Mental Composite Scores were nearly equal. On the PHQ-2 (scored 2–8; positive screen ≥3), 86.9% screened positive, a sensitive threshold that identifies any appreciable depressive symptoms rather than probable depression. Perceived stigma showed the 1 Faculty of Medicine, Lincoln University College, Malaysia. Email: anbari.masterscholar@lincoln.edu.my (Corresponding author) 2 Faculty of Medicine, Lincoln University College, Malaysia. most numerous associations with HRQoL, in mixed directions: higher stigma scores were associated with lower Physical Functioning, Bodily Pain and General Health scores and with higher Social Functioning and overall HRQoL scores (all P<.05). Greater social support was linked to better physical functioning. HRQoL did not differ significantly across sociodemographic subgroups.Conclusions: Adults with SCA in Jazan experience substantial multi-domain HRQoL impairment, and most screened positive for depressive symptoms at a sensitive threshold. Perceived stigma showed the most numerous associations with HRQoL, though not uniformly in the adverse direction, and merits longitudinal study. Integrating routine depression screening with confirmatory assessment, and stigma-reduction programmes, into sickle cell care pathways is warranted.Limitations: The cross-sectional design precludes causal inference. Convenience sampling from a single clinic may limit generalisability, and self-report measures may be affected by social desirability bias. A multivariable model could not be reliably fitted given the sample size, so associations are reported at the bivariate level only.