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Cited by 38Cystic Fibrosis Research AdvancesFamily and Patient Care in Intensive Care UnitsFamily and Disability Support Research

Rates of depression and anxiety in Italian patients with cystic fibrosis and parent caregivers: Implementation of the Mental Health Guidelines

Open access
Graziano, Sonia, Spanò, Barbara, Majo, Fabio, Righelli, Dario, Vincenzina, Lucidi, Quittner, Alexandra, Tabarini, Paola·2020·Respiratory Medicine
DOI 10.1016/j.rmed.2020.106147
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Abstract

BACKGROUND Individuals with chronic respiratory conditions are at-risk for depression and anxiety. In the largest mental health screening study of over 6000 people with cystic fibrosis (CF) and 4000 parent caregivers (TIDES, 2014), rates of symptomatology were two to three times higher than in the general population. International guidelines recommend annual screening of mental health. This is the first study to implement these guidelines in one of the largest CF Centers in Italy. METHODS All individuals with CF, 12 and older (n = 167) and caregivers of children with CF (n = 186), birth to 18, were screened. Health outcome data were also collected (i.e FEV1, BMI, pulmonary exacerbations, CF-related diabetes). Prevalence data and associations between psychological symptoms and health outcomes were examined. RESULTS A high percentage of patients and parent caregivers reported scored above the clinical cut-off for depression and anxiety (37%-48% of adolescents, 45%-46% of adults, 49%-66% of mothers and fathers). Most scores fell in the mild range, however, over 30% were in the moderate to severe range. Elevations in depression and anxiety were correlated. Adolescents who had more pulmonary exacerbations reported higher anxiety. Adults with recent events of hemoptysis reported higher symptoms of depression. CONCLUSIONS Symptoms of depression and anxiety were elevated in both individuals with CF and parents. Implementation of mental health screening was critical for identifying th…

Integrity signals

Registry

Crossref · 10.1016/j.rmed.2020.106147

Cites

39 of 39 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

20 of 42 cited sources checked · 15 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Small screening studies at single centers in the Netherlands, UK and US found lower rates of moderate and severe symptomatology, about 7-10% of adults.

    “In contrast, small screening studies at single centers in the Netherlands, UK and US have found lower rates of moderate and severe symptomatology, about 7-10% of adults [33][34][35]”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [33] Verkleij, 2018, Implementing the international committee on mental health in cystic fibrosis (ICMH) guidelines: screening accuracy and referral-treatment pathways, J. Cyst. Fibros. source
    • cites [34] Quon, 2015, Prevalence of symptoms of depression and anxiety in adults with cystic fibrosis based on the PHQ-9 and GAD-7 screening questionnaires, Psychosomatics source
    • cites [35] Duff, 2016, Implementing ICMH-CF (International Committee on Mental Health in CF) guidance on screening for depression and anxiety symptoms: a feasibility and pilot study, J. Cyst. Fibros. source
  • Premisecitation

    A recent study in Sweden, which screened 100 adults with CF, found that 21% scored in the moderate to severe range on both the depression and anxiety screener.

    “whereas a recent study in Sweden, which screened 100 adults with CF, found that 21% of these individuals scored in the moderate to severe range on both the depression and anxiety screener [36].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [36] Järvholm, 2020, Patient acceptance and outcome of mental health screening in Swedish adults with cystic fibrosis, Qual. Life Res. source

      The Results > Patients section reports that 21 of 100 patients (21%) scored in the at-least-moderate range on the anxiety screener, the depression screener, or both. Only nine patients scored in that range on both screeners, so the cited sentence incorrectly applies 21% to the overlap. (LLM, conf=0.95)

      Experimental — accuracy not yet measured
  • Interpretationreasoning

    Italian prevalence statistics are higher than those published in the TIDES study.

    “These Italian prevalence statistics are higher than those published in the TIDES study [12] most likely because the screening tools recommended in the guidelines are more sensitive to these symptoms [33].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Quittner, 2014, Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of the International Depression Epidemiological Study across nine countries, Thorax source
  • Interpretationcitation

    These results converge with those reported in the TIDES study.

    “These results converge with those reported in the TIDES study [12], and suggest that both depression and anxiety should be a focus of interventions.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Quittner, 2014, Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of the International Depression Epidemiological Study across nine countries, Thorax source
  • Interpretationown data

    The average lung function in this Italian CF Center is substantially higher than that reported by Quon et al. in the US and the TIDES study.

    “Average lung function for the sample of 113 adults was 76% predicted (SD = 23), which is substantially higher than the average lung function reported by both the Quon et al.'s in the US [34] and the TIDES study [12].”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [34] Quon, 2015, Prevalence of symptoms of depression and anxiety in adults with cystic fibrosis based on the PHQ-9 and GAD-7 screening questionnaires, Psychosomatics source
    • cites [12] Quittner, 2014, Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of the International Depression Epidemiological Study across nine countries, Thorax source
  • May combine two claims. 24
  • Classified as probably not a substantial claim. 29
  • The quote only partly states this claim. 1

  • May combine two claims.

    Premisecitation

    In the largest mental health screening study to date in nine countries, including 6088 individuals with CF and 4102 parent caregivers, elevated symptoms of depression were found in 19% of adults, 10% of adolescents, 37% of mothers and 31% of fathers.

    “In the largest mental health screening study to date in nine countries, which included 6088 individuals with CF and 4102 parent caregivers, a substantial proportion reported elevated symptoms of depression and anxiety.Elevated symptoms of depression were found in 19% of adults, 10% of adolescents, 37% of mothers and 31% of fathers.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Quittner, 2014, Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of the International Depression Epidemiological Study across nine countries, Thorax source

  • May combine two claims.

    Interpretationnone given

    This is the first study to implement the International Mental Health Guidelines in a large CF Center in Italy, and one of the first studies to examine symptoms of depression and anxiety in both patients and parent caregivers in Europe using the recommended screening tools.

    “This is the first study to implement these guidelines in one of the largest CF Centers in Italy.”
    • Also stated in: § 5. Discussion · plain
      “This is the first study to implement the International Mental Health Guidelines [15] in a large CF Center in Italy, and one of the first studies to examine symptoms of depression and anxiety in both patients and parent caregivers in Europe using the recommended screening tools.”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] Quittner, 2015, International committee on mental health in cystic fibrosis: cystic fibrosis foundation and European cystic fibrosis society consensus statements for screening and treating depression and anxiety, Thorax source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    In that study, elevated symptoms of anxiety were found in 32% of adults, 22% of adolescents, 48% of mothers and 36% of fathers.

    “Elevated symptoms of anxiety were found in 32% of adults, 22% of adolescents, 48% of mothers and 36% of fathers [12].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Quittner, 2014, Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of the International Depression Epidemiological Study across nine countries, Thorax source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Depression is linked to increased systemic inflammation.

    “New research indicates that depression, in particular, is linked to increased systemic inflammation [21,22].”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [21] Berk, 2013, So depression is an inflammatory disease, but where does the inflammation come from?, BMC Med. source
    • cites [22] Waclawiková, 2018, Role of microbiota and tryptophan metabolites in the remote effect of intestinal inflammation on brain and depression, Pharmaceuticals source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The PHQ-9 has excellent internal consistency (Cronbach's alpha = 0.86-0.89), sensitivity and specificity, and is recommended as the best tool by major international guidelines committees.

    “It is the most widely used screening measure of depressive symptoms, with extensive reliability and validity data, [25,26] and is recommended as the best tool by all major international guidelines committees (e.g., NICE guidelines; National Collaborating Center for Mental Health) [27,28].It has excellent internal consistency (Cronbach's alpha = 0.86-0.89)[29], sensitivity and specificity [30].”
    Quote in the paperNot a substantial claim2 of 5 sources checked
    • cites [25] Kroenke, 2001, Validity of a brief depression severity measure, J. Gen. Intern. Med. source
    • cites [26] Kroenke, 2010, The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review, Gen. Hosp. Psychiatr. source
    • cites [27] 2005

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [28] 2011

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [29] Kroenke, 2001, Validity of a brief depression severity measure, J. Gen. Intern. Med. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Individuals with chronic respiratory conditions, including CF, non-CF bronchiectasis, and COPD, have high prevalence of psychological distress, with rates of depression and anxiety ranging from 20% to over 51%.

    “The prevalence of psychological distress is also high across a variety of chronic respiratory conditions, including cystic fibrosis (CF), non-CF bronchiectasis, and chronic obstructive pulmonary disease (COPD).Rates of depression and anxiety in these conditions have ranged from 20% to over 51% [7,8].”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [7] Riekert, 2007, The association between depression, lung function, and health-related quality of life among adults with cystic fibrosis, Chest source
    • cites [8] Bock, 2017, Screening tools for evaluation of depression in Chronic Obstructive Pulmonary Disease (COPD). A systematic review, Eur Clin Respir J source

      The Discussion reports elevated depression and anxiety in COPD and gives depressive-symptom rates of 35% overall and 67% in severe COPD. It does not address cystic fibrosis or non-CF bronchiectasis, or establish the stated 20%–over-51% range across all three conditions. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A positive depression screen is associated with earlier mortality.

    “A positive depression screen has also been associated with earlier mortality [20].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] Schechter, 2020, Decreased survival in cystic fibrosis patients with a positive screen for depression, J. Cyst. Fibros. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    International guidelines recommend annual screening of mental health symptoms using reliable and valid screening tools, with algorithms for addressing elevated scores and need for psychological or medication-based interventions.

    “This led to the development of international guidelines recommending annual screening of mental health symptoms, using more reliable and valid screening tools.These international guidelines included algorithms for addressing elevated scores and the need for psychological or medication-based interventions [15].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [15] Quittner, 2015, International committee on mental health in cystic fibrosis: cystic fibrosis foundation and European cystic fibrosis society consensus statements for screening and treating depression and anxiety, Thorax source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    There are increasing rates of suicide among healthy individuals, ages 15-35 years, both in the US and Europe.

    “This issue is timely both because there are increasing rates of suicide among healthy individuals, ages 15-35 years, both in the US and Europe [38]”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [38] Bachmann, 2018, Epidemiology of suicide and the psychiatric perspective, Int. J. Environ. Res. Publ. Health source

      Section 3.2 (Age; page unavailable) reports that suicide is a leading cause of death among young people, including those up to age 34 in US statistics. It does not report increasing suicide rates among healthy people aged 15–35 in both the US and Europe. Section 3.1 (Suicide Worldwide; page unavailable) instead describes a decline in European suicide rates since 1980, though it does not give a trend for that age group. (LLM, conf=0.86)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Depression is associated with poor adherence, avoidance of clinic visits, greater morbidity and earlier mortality.

    “Given that depression, in particular, is associated with poor adherence, avoidance of clinic visits, greater morbidity and earlier mortality, we must implement standardized screening processes and incorporate evidence-based, brief interventions into CF Centers [20].”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [20] Schechter, 2020, Decreased survival in cystic fibrosis patients with a positive screen for depression, J. Cyst. Fibros. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the TIDES study across 9 countries, mean lung function for adults was 62.3% pred.

    “In the Quon study of adults, mean FEV 1 % pred was 54.8% and in the TIDES study across 9 countries, mean lung function for adults was 62.3% pred.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Quittner, 2014, Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of the International Depression Epidemiological Study across nine countries, Thorax source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In the TIDES study, only IVs and other markers of pulmonary exacerbations and events, such as hemoptysis, were related to depression and anxiety.

    “These results are similar to those found in the TIDES study [12], in which only IVs and other markers of pulmonary exacerbations and events, such as hemoptysis, were related to depression and anxiety.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] Quittner, 2014, Prevalence of depression and anxiety in patients with cystic fibrosis and parent caregivers: results of the International Depression Epidemiological Study across nine countries, Thorax source

      The Predictors of depression and anxiety section (p. 1094) links intravenous antibiotics and haemoptysis/pneumothorax with elevated symptoms. But it also identifies associations with age, sex, lung function, BMI, transplant listing, and psychological treatment, so the claim that *only* the stated medical events were related is not supported. (LLM, conf=0.88)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The algorithms presented in the guidelines suggest a brief check-in with psychological support for those in the mild range; evidence-based psychological interventions for those in the moderate range; and a combination of psychological and psychopharmacological interventions for those in the severe range.

    “The algorithms presented in the guidelines suggest: a brief check-in with psychological support for those in the mild range; evidence-based psychological interventions (e.g., cognitive behavioral therapy) for those in the moderate range; and a combination of psychological and psychopharmacological interventions (e.g., antidepressants) for those in the severe range [15].”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [15] Quittner, 2015, International committee on mental health in cystic fibrosis: cystic fibrosis foundation and European cystic fibrosis society consensus statements for screening and treating depression and anxiety, Thorax source

      Split into 3 atoms — 2 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Screening data indicated that over one-third of adolescents and nearly half of adults screened above the cut-off for depression and approximately half of the caregivers also scored above the clinical cut-off for depression.

    “Screening data indicated that over one-third of adolescents and nearly half of adults screened above the cut-off for depression and approximately half of the caregivers also scored above the clinical cut-off for depression.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    In the Italian cohort, 45% of adults scored above the depression cut-off, with 25% in the moderate to severe range.

    “in the Italian cohort, 45% of adults scored above the depression cut-off, with 25% in the moderate to severe range.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Levels of comorbidity between depression and anxiety were very high, with ICCs ranging from 0.84 to 0.90.

    “Results across all respondents indicated that levels of comorbidity were very high, ICCs ranged 0.84 to 0.90.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Symptoms of anxiety were very common, with nearly 50% of the patient sample scoring above the cut-off and more than half of the parents also scoring in the elevated range.

    “Symptoms of anxiety were also very common, with nearly 50% of the patient sample scoring above the cut-off and more than half of the parents also scoring in the elevated range.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    No significant associations were found between lung function and BMI and symptom scores for adolescents and adults with CF.

    “No significant associations were found between lung function and BMI and symptom scores for adolescents and adults.”
    Quote in the paperNot a substantial claim

  • The quote only partly states this claim.

    Findingown data

    3% of adults endorsed suicidal ideation.

    “A high number of adolescents and parent caregivers reported suicidal ideation in this study (11% of adolescents, 7% of mothers), whereas, only 3% of adults endorsed this item.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    In the figure, 45% of adults, 61% of mothers, and 49% of fathers scored above the clinical cut-off.

    “45% of adults (N = 51), 61% of mothers (N = 72), and 49% of fathers (N = 34).”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The validated Italian versions of PHQ-9 and GAD-7 were used.

    “The validated Italian version was used in all cases.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    All individuals with CF ages 12 and older, and all parents of children birth to 17 years were approached for screening; there were no refusals.

    “All individuals with CF ages 12 and older, and all parents of children birth to 17 years were approached for screening; there were no refusals.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Over a period of 1 year, 167 consecutive patients (54 adolescents, 113 adults) and 186 consecutive parents (117 mothers, 69 fathers) were screened.

    “Over a period of 1 year, we screened 167 consecutive patients (54 adolescents 12-17 years, 113 adults ages ≥18) and 186 consecutive parents (117 mothers, 69 fathers).”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Prevalence estimates were based on published cut scores for the PHQ-9 and GAD-7.

    “Prevalence estimates were based on published cut scores for the PHQ-9 and GAD-7 [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Manea, 2001, Optimal cut-off score for diagnosing depression with the Patient Health Questionnaire (PHQ-9): a meta-analysis, CMAI Journal

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Premisecitation

    Depression and anxiety negatively affect adherence, clinic attendance, health outcomes, and quality of life.

    “Importantly, numerous studies have shown that depression and anxiety negatively affect adherence, clinic attendance, health outcomes, and quality of life [19].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Barker, 2010, A biopsychosocial model of CF: social and emotional functioning, adherence and quality of life

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Participants were approached consecutively during a routine clinic visit.

    “Participants were approached, consecutively, during a routine clinic visit.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    All patients and parent caregivers completed the screening tools (100%).

    “All patients and parent caregivers completed the screening tools (100%).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was approved by the Bambino Gesù Ethical Committee.

    “This study was approved by the Bambino Gesù Ethical Committee.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Among parents caring for children with chronic respiratory conditions, rates of depression are prevalent, with 20%-37% scoring above a clinical cut-off.

    “Among parents caring for children with chronic respiratory conditions, rates of depression are also prevalent, with 20%-37% of parents scoring above a clinical cut-off [9][10][11].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [9][10][11]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Parents and adolescents completed the screening measures independently to avoid bias.

    “Parents and adolescents completed the screening measures independently to avoid bias.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Respondents in this study were not currently taking any antidepressant medications.

    “Respondents in this study were not currently taking any antidepressant medications.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The GAD-7 has excellent internal consistency (Cronbach's alpha = 0.92) and extensive reliability and validity data.

    “It consists of 7 items measuring symptoms of anxiety and has extensive reliability and validity data.It has excellent internal consistency (Cronbach's alpha = 0.92) [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Spitzer, 2006, A brief measure for assessing generalized anxiety disorder: the GAD-7, Arch. Intern. Med. source

  • May combine two claims.

    Interpretationown data

    Prevalence rates and severity of symptomatology are greater in Italy than the UK.

    “Although prevalence rates and severity of symptomatology are greater in Italy than the UK, they converge with data reported in the TIDES study across 13 Italian CF centers [37].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    In general, a high prevalence of symptoms of depression and anxiety was found in both adolescents and adults with CF, as well as parents.

    “In general, we found a high prevalence of symptoms of depression and anxiety in both adolescents and adults with CF, as well as parents.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    Both adolescents and mothers appeared to be at greatest risk.

    “Thus, both adolescents and mothers appeared to be at greatest risk.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    A large screening study of adults in the UK found that 33% of adults were elevated above the clinical cutoff, with 12.5% in the moderate to severe range.

    “Our data are more similar to a large screening study of adults in the UK, which found that 33% of adults were elevated above the clinical cutoff, with 12.5% in the moderate to severe range [10]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Latchford, 2013, Screening for depression in a single CF Centre, J. Cyst. Fibros. source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The National Health Institute reports that 6-8% of individuals in the general Italian population screen in the elevated range of depression.

    “the National Health Institute reports that 6-8% of individuals screen in the elevated range of depression (https:// www.epicentro.iss.it/mentale/epidemiologia-italia).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    A recent study examining HADS factor structure found that it does yield the two factors of depression and anxiety.

    “Furthermore, a recent study examining its factor structure found that it does yield the two factors of depression and anxiety [40].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [40] Saez-Flores, 2018, Examining the stability of the hospital anxiety and depression scale factor structure in adolescents and young adults with cystic fibrosis: a confirmatory factor Analysis, J. Pediatr. Psychol. source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The CF International Mental Health Guidelines recommend screening all individuals with CF annually, starting at age 12, with annual screening for caregivers of those birth to age 18 years.

    “The CF International Mental Health Guidelines recommend screening all individuals with CF annually, starting at age 12, with annual screening for caregivers of those birth to age 18 years.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    For some sub-analyses, the sample size was small and results should be interpreted with caution.

    “This is a limitation of our study and for some of these sub-analyses, our sample size was small and our results should be interpreted with caution.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S4 (based).

    Premisenone given

    The international mental health guidelines recommended annual screening for both patients and caregivers.

    “Given that the international mental health guidelines recommended annual screening for both patients and caregivers, these implementation results are very encouraging.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationreasoning

    The better lung function found in this Italian CF Center may be the result of prophylactic use of IV antibiotic therapy, which appears to preserve lung function.

    “The better lung function found in this Italian CF Center may be the result of prophylactic use of IV antibiotic therapy, which appears to preserve lung function.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    Mental health screening is urgently needed in CF centers.

    “This indicated that mental health screening is urgently needed in CF centers, both to identify those who require psychological support and to provide appropriate treatment for those in the moderate to severe range of symptomatology.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Interpretationown data

    The need for psychological support is great.

    “suggesting that the need for psychological support is great.”
    Quote in the paperNot a substantial claim
44 of 44

  • The paper relies on this without support.

    Mild symptoms of depression and anxiety in individuals with CF and caregivers are at-risk to develop more severe symptoms.

    “Although a majority of patients and parents reported symptoms in the mild range, it is important to identify them given that they are at-risk to develop more severe symptoms.”

  • The paper relies on this without support.

    Early identification and preventative interventions can prevent mild symptoms from increasing and leading to a debilitating clinical diagnosis.

    “Thus, our hope is to prevent these symptoms from increasing and leading to a debilitating clinical diagnosis.”

  • The paper relies on this without support.

    Identifying individuals in the mild range prevents further progression of symptoms.

    “Given that our focus is on identification of those who are at-risk, it is important to identify those in the mild range to prevent further progression of these symptoms.”

  • The paper relies on this without support.

    Without annual screening, we would not likely be aware of suicidal thoughts.

    “If we did not perform annual screening, we would not likely be aware of these suicidal thoughts, which should be addressed clinically.”

  • The paper relies on this without support.

    Few screening studies in individuals with chronic respiratory conditions have included a question about suicidal ideation in their mental health assessment.

    “few screening studies in individuals with chronic respiratory conditions have included this question in their mental health assessment.”

  • The paper relies on this without support.

    The CF community was not aware of the issue of suicidal ideation in CF.

    “Inclusion of this question has highlighted an issue the CF community was not aware of.”

  • The paper relies on this without support.

    To date, few studies have examined the prevalence of depression and anxiety in complex chronic respiratory conditions such as COPD, non-CF bronchiectasis, non-tuberculosis mycobacteria, and primary ciliary dyskinesia.

    “To date, few studies have examined the prevalence of depression and anxiety in these very challenging chronic illnesses.”

  • The paper relies on this without support.

    The CF mental health guidelines and algorithms for intervention provide a successful model for integrating mental health into the physical care of those with complex, chronic respiratory conditions.

    “The CF mental health guidelines and algorithms for intervention provide a successful model for integrating mental health into the physical care of those with complex, chronic respiratory conditions.”
8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Maternal anxiety is described with the opposite BMI direction

    Major

    The prose says mothers of adolescents had higher anxiety when their children's BMI was lower. The corresponding table entry is a positive correlation (r = .29), indicating higher anxiety scores with higher BMI.

  • Anxiety screening is described as positive for a majority of patients

    Minor

    Neither patient age group reached a majority above the anxiety cut-off: the reported rates are 48% for adolescents and 46% for adults.

  • The reported dyad total does not match its components

    Minor

    The stated mother-adolescent and father-adolescent dyad counts add to 65, not 64. Table 3 separately lists 48 mother-adolescent dyads, which would produce the reported total.

    Reported 64 · recomputed 65

  • Adolescent anxiety-score SD differs between the prose and table

    Minor

    The Results give an adolescent GAD-7 standard deviation of 3.1, while Table 1 gives 3.6 for the same mean and group.

4 of 4

Cites

Flagged first, then by citations

1 of the 40 references couldn’t be matched to a known paper.

Research works printed but not linked: 1

  1. Kroenke, 2001, Validity of a brief depression severity measure, J. Gen. Intern. Med., 16, 606, 10.1046/j.1525-1497.2001.016009606.x · DOI · Paper page

Cited by

Sorted by citations

Related

Authors
Graziano, S., Spanò, B., Majo, F., Righelli, D., Vincenzina, L., Quittner, A., & Tabarini, P.
Affiliations
  • Bambino Gesù Children's Hospital (IT)
  • Fondazione Santa Lucia (IT)
  • Istituto per le Applicazioni del Calcolo Mauro Picone (IT)
Corresponding author
Graziano, Sonia
ORCID
Venue
Respiratory Medicine
Publisher
Elsevier BV
Published
2020-10
Volume
172
Pages
106147
ISSN
0954-6111 (ISSN-L)
DOI
10.1016/j.rmed.2020.106147
OpenAlex
W3084325033
Cited by
38
References
40
Citations by year
2026: 5 · 2025: 7 · 2024: 8 · 2023: 6 · 2022: 6 · 2021: 5
FWCI
1.99
Type
journal article
Language
en
Open access
Licence
Locations
  • Respiratory Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Padua Research Archive (University of Padova) (submittedVersion)
Funders
  • Furthermore
  • CF
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
  • Health Sciences › Health Professions › Radiological and Ultrasound Technology › Family and Patient Care in Intensive Care Units
  • Social Sciences › Psychology › Clinical Psychology › Family and Disability Support Research
Keywords
cystic fibrosis, depression, anxiety, parental caregivers, mental health screening, mental health guidelines, pulmonary exacerbations, hemoptysis
MeSH terms
Adolescent, Adult, Anxiety Disorders, Child, Cystic Fibrosis, Depression

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-11.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-11.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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