KINGSTON, Jamaica—Research has found a strong correlation between painful periods and high rates of depression, anxiety and suicidal thoughts among women living with sickle cell disease.

The study, conducted by Research Fellow at the Sickle Cell Unit, Caribbean Institute for Health Research, University of the West Indies (UWI), Dr Zachary Ramsay, was presented at the 16th Annual National Research Conference held earlier this year at The Jamaica Pegasus hotel in New Kingston.

He said that the situation presents a potential public health crisis that demands urgent intervention and more comprehensive patient care.

Sickle cell disease is an inherited blood disorder caused by the abnormal haemoglobin S, which leads red blood cells to become rigid and sickle-shaped.

These distorted cells can block blood vessels, causing anaemia, severe pain episodes, organ damage and frequent hospitalisations. While the physical burden of the disease has long been recognised, Ramsay noted that growing evidence points to significant psychological challenges among patients, particularly women.

“Many patients living with sickle cell disease experience very high morbidity, frequent hospital use, and increased rates of depression and anxiety, and these rates tend to be higher among women,” Dr Ramsay pointed out.

The study sought to explore whether menstrual health issues, specifically dysmenorrhea (painful menstruation) and heavy menstrual bleeding, were linked to depression and anxiety among women with sickle cell disease.

Dr Ramsay said that previous research in the general population had suggested such connections, but no previous study had prospectively examined these relationships in women with sickle cell disease.

Research Fellow at the Sickle Cell Unit, Caribbean Institute for Health Research, University of the West Indies (UWI), Dr. Zachary Ramsay.

In conducting the study, researchers recruited 125 women aged 18 years and older from the Sickle Cell Unit, with an average age of 29 years.

Participants represented all sickle cell genotypes, with nearly 80 per cent having severe sickle cell genotypes. Pregnant women and those who had recently used hormonal contraceptives were excluded.

Each participant attended two study visits timed to different phases of the menstrual cycle, allowing researchers to measure hormone levels and collect information on menstrual symptoms, quality of life, depression and anxiety.

Validated screening tools were used to assess mental-health risks. Women were classified as being at risk for major depression or generalised anxiety disorder if they scored 10 or higher on internationally recognised questionnaires.

Presenting the findings, Dr Ramsay said that menstrual bleeding was not found to be particularly heavy, overall, but menstrual pain was a significant concern. More than one-third of participants reported experiencing premenstrual symptoms often or always, including breast tenderness, abdominal pain and bloating.

What stood out most, however, were the mental health findings. Almost 45 per cent of participants screened positive for major depression, while just over 39 per cent screened positive for generalised anxiety disorder.

Nearly one-third of the women reported passive suicidal ideation. “These rates are strikingly higher in terms of prevalence than what we’ve seen previously reported in the literature,” Dr Ramsay said.

He pointed out that depression rates were considerably higher than those recorded in Jamaica’s Health and Lifestyle Survey and significantly exceeded figures previously measured among sickle cell patients at the unit in 2010.

Comparisons with a landmark longitudinal study in the United States (US) revealed that Jamaican women with sickle cell disease were experiencing rates of depression and anxiety approximately three times higher than their American counterparts.

The study also identified a strong relationship between painful menstruation and depression risk, with women reporting more severe dysmenorrhea being significantly more likely to screen positive for major depression.

In contrast, better quality-of-life measures related to sleep, pain and physical functioning were associated with lower risks of both depression and anxiety.

Dr Ramsay said the findings suggest that improving quality of life could be a practical strategy for reducing mental health burdens in this vulnerable group.

He noted that one surprising finding was that hormone levels themselves did not appear to influence depression or anxiety risk.

In addition, he said that women with milder sickle cell genotypes appeared to experience greater anxiety than those with more severe forms of the disease. Although counterintuitive, Dr Ramsay said this finding is increasingly being observed in international studies.

He suggested that patients with milder disease may receive less medical attention, fewer disease-modifying therapies and reduced access to curative interventions, which can create uncertainty about their health and future, a factor previously linked to poorer mental health outcomes.

Dr Ramsay said that routine screening for depression, anxiety and menstrual disorders should become a standard component of care for women living with sickle cell disease.

He advocated for a multidisciplinary approach involving haematologists, mental health professionals, gynaecologists and other specialists working together to address the complex challenges these patients face.

Without targeted interventions, he said that a large number of women may continue to suffer in silence from conditions that remain under-recognised but are profoundly affecting their quality of life.

The World Health Organization (WHO) provides comprehensive guidelines for managing sickle cell disease (SCD), emphasising early diagnosis, infection prevention, and disease-modifying therapies to reduce complications.

Care protocols are heavily tailored for children, adolescents, and pregnant women to improve survival and quality of life.

-JIS