Abstract：
BACKGROUND: There are very few large population-based studies studying mental health in persons with von Willebrand disease (PwVWD).
OBJECTIVE: We aim to assess prevalence of depression and anxiety in PwVWD over a period of 20 years and identify bleeding symptoms that may be more likely associated with depression and anxiety in PwVWD.
METHODS: This is a retrospective cohort study using a deidentified national dataset from 1118 hospitals with 176 million patients. Cases were defined as patients aged 0-110 years, both male and female, with von Willebrand disease (VWD), without hemophilia. Controls were defined as patients aged 0-110 years, both male and female, without VWD or hemophilia. We compared rates of depression and anxiety in cases and controls and by type of bleeding symptoms.
RESULTS: We identified 66 367 PwVWD and 183 890 766 controls. The prevalence of depression (23.12% vs 8.62%; p ≤ .00093; relative risk = 2.68) and anxiety (32.90% vs 12.29%; p ≤ .00093; relative risk = 2.68) was higher in PwVWD. Most of the bleeding symptoms were associated with higher rates of depression and anxiety in PwVWD with the highest rates with abnormal uterine bleeding, hematemesis, hemoptysis, hematuria, and melena.
CONCLUSIONS: Our study shows that mental health disorders in PwVWD are a significant health burden, and that burden is increased with documented bleeding symptoms. It is important that primary care physicians and hematologists caring for this population recognize this increased risk and appropriately screen and refer to mental health professionals.
OBJECTIVE: We aim to assess prevalence of depression and anxiety in PwVWD over a period of 20 years and identify bleeding symptoms that may be more likely associated with depression and anxiety in PwVWD.
METHODS: This is a retrospective cohort study using a deidentified national dataset from 1118 hospitals with 176 million patients. Cases were defined as patients aged 0-110 years, both male and female, with von Willebrand disease (VWD), without hemophilia. Controls were defined as patients aged 0-110 years, both male and female, without VWD or hemophilia. We compared rates of depression and anxiety in cases and controls and by type of bleeding symptoms.
RESULTS: We identified 66 367 PwVWD and 183 890 766 controls. The prevalence of depression (23.12% vs 8.62%; p ≤ .00093; relative risk = 2.68) and anxiety (32.90% vs 12.29%; p ≤ .00093; relative risk = 2.68) was higher in PwVWD. Most of the bleeding symptoms were associated with higher rates of depression and anxiety in PwVWD with the highest rates with abnormal uterine bleeding, hematemesis, hemoptysis, hematuria, and melena.
CONCLUSIONS: Our study shows that mental health disorders in PwVWD are a significant health burden, and that burden is increased with documented bleeding symptoms. It is important that primary care physicians and hematologists caring for this population recognize this increased risk and appropriately screen and refer to mental health professionals.
摘要：
背景：很少有基于人群的大型研究研究vonWillebrand病（PwvWD）患者的心理健康。
目的：我们的目的是评估PwvWD患者在20年内抑郁和焦虑的患病率，并确定PwvWD患者更可能与抑郁和焦虑相关的出血症状。
方法：这是一项回顾性队列研究，使用来自1,118家医院的非识别国家数据集，有1.76亿患者。病例被定义为患者，0-110年,男性和女性，vonWillebrand病（vWD），没有血友病。对照组定义为患者，0-110年,男性和女性，没有vWD或血友病。我们比较了病例和对照组的抑郁和焦虑发生率，以及出血症状的类型。
结果：我们确定了66,367个PwvWD和183,890,766个对照。抑郁症的患病率（23.12%vs8.62%，P=<0.0001，RR=2.68）和焦虑（32.90%vs12.29%，P=<0.0001，RR=2.68）在PwvWD中更高。在PwvWD中，大多数出血症状与较高的抑郁和焦虑发生率相关，其中异常子宫出血的发生率最高。呕血,咯血,血尿,还有Melena.
结论：我们的研究表明，PwvWD中的心理健康障碍是一个巨大的健康负担，随着出血症状的记录，这种负担会增加。重要的是，初级保健医生和血液学家照顾这个人群认识到这种增加的风险，并适当筛选和咨询心理健康专业人员。
目的：我们的目的是评估PwvWD患者在20年内抑郁和焦虑的患病率，并确定PwvWD患者更可能与抑郁和焦虑相关的出血症状。
方法：这是一项回顾性队列研究，使用来自1,118家医院的非识别国家数据集，有1.76亿患者。病例被定义为患者，0-110年,男性和女性，vonWillebrand病（vWD），没有血友病。对照组定义为患者，0-110年,男性和女性，没有vWD或血友病。我们比较了病例和对照组的抑郁和焦虑发生率，以及出血症状的类型。
结果：我们确定了66,367个PwvWD和183,890,766个对照。抑郁症的患病率（23.12%vs8.62%，P=<0.0001，RR=2.68）和焦虑（32.90%vs12.29%，P=<0.0001，RR=2.68）在PwvWD中更高。在PwvWD中，大多数出血症状与较高的抑郁和焦虑发生率相关，其中异常子宫出血的发生率最高。呕血,咯血,血尿,还有Melena.
结论：我们的研究表明，PwvWD中的心理健康障碍是一个巨大的健康负担，随着出血症状的记录，这种负担会增加。重要的是，初级保健医生和血液学家照顾这个人群认识到这种增加的风险，并适当筛选和咨询心理健康专业人员。
