Dr. Beth A. Smith with the University at Buffalo has received a mental healthcare award from the Cystic Fibrosis Foundation for her work in advancing the understanding and care of mental health in cystic fibrosis — regarding both the prevalence of depression among patients and its impact on treatment.
The 2017 Carolyn and C. Richard Mattingly Leadership in Mental Health Care Award was introduced in 2016. Each year, it acknowledges a person who has displayed leadership and commitment in the area of CF patients’ mental health.
“It is gratifying that there is now an award to recognize mental health work in CF,” Smith, a clinical associate professor of psychiatry and division chief of child and adolescent psychiatry at Jacobs School of Medicine and Biomedical Sciences, said in a press release.
“It helps to validate that mental health and well-being are as equally important as physical health. It’s a proud moment for all of us in mental health,” she added.
With the support of a grant from the American Academy of Child & Adolescent Psychiatry, Smith has investigated the impact of depression on treatment adherence. The study was the first of its kind, exploring the link in children as young as 8 years old.
“We looked at their adherence to airway clearance, which can sometimes take up to 50 minutes a day,” she said.
The impact of depression
Smith’s interest in the link between mental well-being and treatment adherence stemmed from her years as a resident and during a fellowship in child and adolescent psychiatry.
During this time, she connected with Daniel W. Sheehan, a clinical associate professor of pediatrics.
“We had a lot of shared interests and thoughts about how mental health affects physical health,” Smith said. “He really introduced me to CF, which is a multi-systemic illness, and one of the toughest, in that the treatment regimen is so complex and lifelong.”
“There are a lot of people who may have complex regimens, but they are in and out of it, such as a cancer treatment,” she added.
Thinking about these aspects, the two researchers started wondering how people coped with the treatment.
“We wondered what the qualities were that enabled someone to take that on,” Smith said. They also turned the question around, wondering what factors made treatment adherence more difficult.
It turned out that data had a clear message to transmit.
First, depression rates were high among CF-affected children — three times that of healthy children. And depression took its toll.
“What we found was that children who were depressed were much less likely to do the treatment regimen and actually were more likely to do zero. It was astonishing,” she said.
Both a child’s mental health, and depression in parents, impacted treatment and treatment adherence. Smith believes that depression among parents might lead to poorer supervision or access to treatments.
Treating mental well-being
Last year, Smith’s mentor and colleague Alexandra L. Quittner, a professor of psychology at the University of Miami, received the award. Quittner’s work confirmed that, globally, CF patients consistently have depression rates two to three times that seen in the general population.
The study spurred the CF Foundation to develop expert guidelines on depression in CF. The guidelines were created by an international committee — Smith was asked to lead a subgroup on screening for the committee.
When the guidelines were published in 2015, Smith led the task force that worked to implement them.
“The Foundation encouraged both practical and pie-in-the-sky ideas,” Smith said. “They asked us to think about what we would like to see done, without worrying about other constraints.”
Among her ideas was to include a mental health coordinator in the multidisciplinary CF care teams.
“The teams are already very multidisciplinary. They often have a nutritionist, a pulmonologist, and an endocrinologist. Why not have mental health disciplines be a part of that to help coordinate screenings and referral?”
The foundation has now funded 80 CF Centers across the U.S. to hire mental health coordinators. The funding covers the first year of employment.
The CF Foundation also formed a mental health advisory committee, which had the task of helping sustain its various initiatives. Smith chaired the committee while studying how depression screening could be implemented. She developed screening tools that later were adopted by institutions worldwide.
Her work has also sought to reduce the shame linked to depression.
“It is important for healthcare providers to ask CF patients not only how they are feeling physically, but to also inquire about their mental well-being,” she said. “It is about removing the stigma of depression; teaching patients not to apologize for it because this might be part of their illness.”