Sickle Cell Disease (SCD): A Model for Developing Science in Health Disparities Christopher L....

Sickle Cell Disease (SCD): A Model for Developing Science in Health Disparities

Christopher L. Edwards, Ph.D., BCIAC, IABMCP

Duke University Medical Center

Department of Medicine, Division of Hematology

Department of Psychiatry

Medical Director, Biofeedback Laboratory and Pediatric Neuropsychology Service

Director, Chronic Pain Management Program

Duke University Medical Duke University Medical CenterCenterDepartment of Psychiatry and Behavioral Sciences

Acknowledgements to Co-authors Mary Wood, M.A. Miriam Feliu, Psy.D. Gary Bennett, Ph.D. Shani Harris, Ph.D. Laura M. De Castro, M.D. Mary Abrams, MPH Elaine Whitworth, MSW, MPA Camela McDougald, M.A. Keith Whitfield, Ph.D. Goldie Byrd, Ph.D. Jude C. Jonassaint, RN Lesco Rogers, M.D. Linda Weaver Patrick Logue, Ph.D. Michelle Pearce, Ph.D. Cara O’Connell, Ph.D. Asha S. Payne, M.D. Zakiyah Jones, M.A. Lekisha Edwards, Ph.D. Veeraindar Goli, M.D. Alvin Killough, Ph.D.

Dean Elwood Robinson, Ph.D. Marcellus Merritt, Ph.D. M. Ojinga Harrison, M.D. Anita Holmes, JD, MPH April Hargrove, M.A. Brittani Leach-Beale Renee Dunn, Ph.D. Janice McNeil, Ph.D. Jennifer Pells, Ph.D. Katherine Presnell, Ph.D. Katherine Applegate, Ph.D. Chante’ Wellington, Ph.D. Lauren Durant, Ph.D. Stephanie Canada, Ph.D. Jeffrey Greeson, Ph.D. Stephanie Johnson, Ph.D. Elizabeth Phillips, MD Shiv Sudhakar, M.D. Mischca Scales, Ph.D. Amy Wachholtz, Ph.D., M.Div Markece Mathis, MA

Lydia Scott, B.A. Kofi Horton, M.A. Patricia Pritchette, BA Aurrielle Cobb, BA Keisha O’Garo, Psy.D. Kai Morgan, Psy.D. Amy Goetzinger, Ph.D. Cara O’Connell-Edwards, Ph.D. Chanda Lee Erica Harrell, M.A. Dariene Guinyard Malik Muhammad, Ph.D.


Acknowledgements to Institutions Duke University Duke University Medical Center Xavier University North Carolina State University NIH North Eastern Clinical Services Winston-Salem State University Southern Methodist University Dana-Farber Cancer Institute University of the West Indies,

Jamaica NC A&T State University

John Hopkins University Harvard School of Public Health North Carolina Central

University Harvard Medical Center NHLBI University of NC- Chapel Hill Drexel University Medical

School Pennsylvania State University Office of Health and Human

Services, General Baptist State Convention of North Carolina

Yale School of Medicine


Presentation Objectives1. Present a context in which to justify the scientific pursuit of health

disparities;

2. Present current research findings on SCD from our ongoing research program as a representative of a health disparity;

3. Model the development of health disparities research from clinical observations to the publication of findings.

4. Invite Caribbean collaboration/ participation


2009 Medline Search

316, 923 published articles on Pain (Acute, Chronic, Somatic, Disease, etc.)


2009 Medline Search

316,923 published articles on Pain 15,444 published articles on Chronic

or Intractable Pain


2009 Medline Search

316,923 published articles on Pain 15,444 published articles on Chronic or

Intractable Pain 1355 SCD + Pain

.004 % of the lite

rature focused on SCD Pain


2009 Medline Search 316,923 published articles on Pain 15,444 published articles on Chronic or

Intractable Pain 1355 SCD + Pain 26 Psychosocial in SCD

.00008 % of th

e liter

ature

focused on

Psychosocial Is

sues in SCD Pain


Keefe, Lumley, Buffington, Carson, Studts, Edwards et al., Psychosomatic Medicine 2002; 64:921-938.


Pathophysiology Of Pain, Disease, and Health In African Americans As a Complex Interaction Between Biological, Psychological, and Social Processes

Biological

Cognitive/Behavioral Emotional

PAINPAIN

Social Context

Social ContextSocial Context

Edwards, Feliu, Johnson, Webster, Bennett, Bishop, Samios, Ellison-Manuel, Martinez (2005). The application of cognitive-behavioral techniques for the management of complicated and persistent gout pain. Ciencias de la Conducta, 20, 89-116


Sickle Cell Disease


Edwards et al., International Journal of Behavioral Medicine 2005; 12(3):171-179.


Pells, Presnell, Edwards et al., Journal of the National Medical Association2005; 97(12) :1622-1629


Pells, Edwards et al., Clinical Journal of Pain 2007; 23(8):707-713.


Edwards et al., Journal of the National Medical Association2006; 98(3):420-428


Edwards et al., Neuropsychiatric Disease and Treatment 2007; 3(6):705-709.


Edwards & Rogers, Journal of Pain2007:8(10):824-825.


Harrison, Edwards, et al., Journal of Nervous and Mental Disease, 2005; 193(4):250-257


The Role of Forgiveness in Individuals with Sickle Cell Disease

Camela McDougald, MA., Christopher Edwards, Ph.D., Chante’ Wellington, Ph.D., Mary Wood, M.A., Miriam Feliu, Psy.D., Janice McNeil, Ph.D, Lekisha Edwards, MA, Dariene Guinyard, Goldie Byrd, Ph.D., Malik Muhammad, Ph.D, Keith E.

Whitfield, Ph.D.

•Patient who report greater forgiveness also report:

•Greater Sensory Pain

•Low levels of feelings of disenfranchisement

•Great Intrinsic Religiosity


The Effects of Active Coping in Sickle Cell Disease (SCD)

1,2,3 Christopher Edwards, Ph.D., 1 Mary Wood, M.A., 1 Chante’ Wellington, Ph.D., 1,3 Miriam Feliu, Psy.D., 1 Lekisha Edwards, Ph.D., Malik Muhammad, Ph.D., 1,3 Camela McDougald, MA., 12 Elwood Robinson, Ph.D., Janice McNeil, Ph.D.,

Yolanda Wall, Ph.D., Keith Whitfield, Ph.D.

Patient who report greater John Henryism also report:

•Low pain intensity, frequency, and duration ratings

•Low disability ratings

•Greater ADL

•Greater overall emotional disturbance


Predictors of Self-Efficacy for Coping With Pain in Individuals with Sickle Cell Disease (SCD)

1 Lekisha Edwards, Ph.D., 1,2,3 Christopher Edwards, Ph.D., 1 Mary Wood, M.A., 1 Chante’ Wellington, Ph.D., 1,3 Miriam Feliu, Psy.D., Janice McNeil, Ph.D., 1,3 Camela McDougald, MA., Elwood Robinson, Ph.D., Keith Whitfield, Ph.D.

The amount of variability in pain throughout the day predicts Self-Efficacy for pain control


The Effects of Adoption on Psychological Functioning in Patients with Sickle Cell Disease (SCD)

Chante’ Wellington, Ph.D., Christopher Edwards, Ph.D., Mary Wood, M.A.,

Lekisha Edwards, Ph.D., Miriam Feliu, Psy.D., Keith Whitfield, Ph.D.,

Janice McNeil, Ph.D., Goldie Byrd, Ph.D., Sabrina Learson

Patients who are adopted, in comparison to those that were not, reported lower levels of:

•Somatization

•OCD

•Depression

•Pain Severity

•Number of comorbid symptoms


Prediction of Mental Health Symptoms from Negative Emotional Reactions to Pain in Adult Patients with Sickle Cell Disease (SCD)

(In Press JNMA)

1,2,3 Christopher Edwards, Ph.D., 4 Alvin Killough, Ph.D., 1 Mary Wood, M.A., 1,3 Camela McDougald, MA., 2 Laura DeCastro, M.D., 1,3 Miriam Feliu, Psy.D., 1

Priyanka Uppal, 3,5 Lesco Rogers, MD, 1 Chante’ Wellington, Ph.D., 6 Keith E. Whitfield, Ph.D. 7 Keisha O'Garo, Psy.D., 8 Kai Morgan, Psy.D., 1 Lekisha Edwards, MA, 9 Goldie Byrd, Ph.D., 10,11 Gary G. Bennett, Ph.D., 12 Patricia

Pritchette, 1,3 Veeraindar Goli, MD, 12 Elwood Robinson, Ph.D.


SELF-REPORTED DEPRESSION AND SUICIDAL IDEATION IN PATIENTS WITH SICKLE CELL DISEASE

(JNMA; Nov. 2009)

Christopher Edwards, Amy Goetzinger, Chante’ Wellington, Mary Wood, Crystal Barksdale, Elwood Robinson, Camela McDougald,

Mary Abrams, Keith Whitfield, Lekisha Edwards, Miriam Feliu, Goldie Byrd, Laura DeCastro


PAIN AND DEPRESSION IN BLACK MEN WITH SICKLE CELL DISEASE (SCD)

Markece Mathis, MA, Christopher Edwards, Ph.D., Lekisha Edwards, Ph.D., Sonia Marrone, Ph.D., Chante’ Wellington, Ph.D., Goldie Byrd, Ph.D., Dorthea Foushee, Ph.D., Malik Muhammad, Ph.D.,

Miriam Feliu, Psy.D., Janice McNeil, Ph.D.

•Greater levels of depression in Black men was found to relate to:

•Greater mean pain intensity over the past month


AGING AMONG ADULT PATIENTS WITH SICKLE CELL DISEASE (SCD) 1,2 Miriam Feliu, Psy.D., 1,2,3 Christopher L. Edwards, Ph.D., 1 Heather R. Romero, MA,

1 Mary Wood, M.A., 4 Goldie Byrd, Ph.D., 1 Lekisha Edwards, Ph.D, 1 Chante’ Wellington, Ph.D., 5 Keith E. Whitfield, Ph.D.

Duke University Medical Center

1 Department of Psychiatry, Duke University Medical Center 2 Duke Pain and Palliative Care Clinic

3 Department of Hematology, Duke University Medical Center

4 North Carolina A&T State University Department of Biology

5 Duke University Department of Psychology


Campbell, Keefe, McKee, Edwards et al. Journal of Pain & Symptom Management

2004: 28(5):433-444.


van Tilburg, M., McCaskill, C.C., Lane, J.D., Edwards, C.L. et al, Psychosomatic Medicine, 2001;63:551-555


Collins-McNeil, Holston, Edwards et al., Archives of Psychiatric Nursing 2007; 21(4):201-209.


Whitfield, Brandon, Robinson, Bennett, Merritt, Edwards, Journal of the National Medical Association 2006; 98(4), 641-647.


Edwards et al., Journal of the National Medical Association

2006; 98(9):1498-1500.


Summary


Take Home Message Disparities in health exist at multiple levels and in

multiple disease states although their mechanisms are not always understood.

Sickle Cell Disease is an extraordinary disease state in which to explore health disparities.

Your contributions are needed and your collaboration is welcomed!


Future Directions Current collaboration with Dr. Kai Morgan in

Jamaica (150 subjects complete)

Longitudinal evaluation of medical and psychosocial factors predicting SCD

Continued translation of models established within SCD to other Black populations towards the reduction of health disparities

Sickle Cell Disease (SCD): A Model for Developing Science in Health Disparities Christopher L....

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