Mental health in persons with von Willebrand disease in the United States – A large national database study

BACKGROUND There are very few large population-based studies studying mental health in persons with von Willebrand disease (PwvWD). OBJECTIVES 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 de-identified national dataset from 1,118 hospitals with 176 million patients. Cases were defined as patients, 0-110 years, both male and female, with von Willebrand disease(vWD), without Hemophilia. Controls were defined as patients, 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 =<0.0001, RR = 2.68) and anxiety (32.90% vs 12.29%, P =<0.0001, RR = 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.